TRANSFORMATION IN THE GROUP

THEODORE K. WHITENECK

Drawings by Joline Whiteneck

In partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

PAIDEIA

San Francisco

June, 1977

Revised 2007, 2018.

PAIDEIA is now an affiliate of Global Network:
PAIDEIA: School of Journeys-School on Borders
www.borderstudiesassociates.net

To Joline, my love, my muse and inspiration.

To Wallace and Edna McAfee
and all the members of Group,
past, present, and future.

A Group is composed of a number of individuals who meet and share themselves with one another. This project is, in many ways, a Group project. A variety of other people have helped form my views. Their insights, perspectives, and comments have been immeasurably valuable to my project and my own Group experience. I have vicariously shared the joy and surprise that comes as we see a person expand and actualize their potentials beyond anything that they dreamed possible. I have also witnessed, hopefully with compassion, the pain felt by some who we, our society, have not been able to help. They, too, have contributed to my understanding. If it were possible I would like to communicate my appreciation to them also.
My friends at Long Beach Memorial Medical Center: staff, physicians, and patients, have given me a great deal of personal encouragement as well as experiential knowledge in transformation. Thanks particularly to Betty Armacost, Neuropsychiatric Department Unit Manager, and Pat Jimenez, Senior Clinical Nurse, both Senior Psychiatric Nurses—true masters (mistresses?) of therapeutic communication as it can be developed. They introduced me to approaches of communication with people with extreme emotional and mental disorder: psychosis [diagnosed as schizophrenia; bi-polar disorder—manic depression as well as depression (major, dysthymic, situational); OBS; dementia (Alzheimr‘s was on the horizon but yet to be identified as a major syndrome.); substance induced psychosis], as well as adolescent behavioral dilemmas, and a vast array of out-of-the-ordinary states of consciousness that gained them admission (often at their own request, but not always) to a Neuro-psychiatric Unit. Also thanks to Joy Phillips, R. N., later Unit Manager, who encouraged the development and presentation of the Crisis Intervention Workshop.

I cannot say too much about the influence of the McAfees and the members of Group on my ideas. I will let the chapters that relate to them speak for themselves.

My parents, Kingery and Margueritte Whiteneck, have given me a great amount of support during the writing.

Barbara Davidson accomplished the task of typing the original project while providing much interesting conversation. Thanks for the word “explicate”, Barbara; it fits it all.

Finally, my wife Joline encouraged me throughout the project with stimulation, support, feedback, and introduced me to the whole field in the first place.

ACKNOWLEDGMENTS

to 2007 revision

I have attempted to revise my original Ph. D. dissertation with a minimal number of changes. That said, a great deal of experience has transpired in the last 30 years. Consequently, I have added a few comments, explanations, and illustrative examples as well as a few additional references. (Note 2017: Actually, now I have added a good deal of autobiographically significant notes, most finding their way to the End Notes; but a few seem to fit into the main text.) These have not really changed any of the basic premises of the original paper. I have led and participated in several additional types of Groups with different procedures and goals. I have also had a great deal of Crisis Intervention experience while employed by Santa Cruz County Department of Mental Health as a Senior Clinician/Crisis Intervention Specialist. While Crisis Intervention is now a regular service of hospitals and mental health departments, it has too often become an intake, evaluation, and referral service, rather than a clinical treatment approach in the manner that it was originally envisioned in the writings of Caplan and Aguilera and Messick. I would also like to extend thanks to my colleagues at Santa Cruz County Mental Health for stimulating and challenging my ideas about both Crisis Intervention and Group development.

In my own practice I have continued to approach family, couple, adolescent, individual adult, and Group issues within a crisis counseling-psychotherapy and role-play framework similar to those that I describe in this study. I have also extended the field of Crisis Intervention into other areas of political analysis, radical education, and public administration. The content of my approach has remained the same while experience has honed certain features. Communication principles have become more important and vital for promoting interpersonal development. Humor and play, which emerged as vital therapeutic qualities in my original research, seem to be not only desirable but also indispensable (such a heavy word for such a light subject!). It seems that play’s quality of surprise is manifested existentially the way it almost pops-up at unexpected times and places and leads to new and imaginative directions! Teachers, child therapists, and, of course, those who have been our parental influences (including baby sitters and tutors), have known this since probably before we became human.

Many thanks to G.T. Toriz for shepherding the text from a half dozen disks (I thought “floppy” referred to the mechanical process by which information was recorded and stored. I now see that it refers to the way the text flops around during the reading and transfer process.), entered on a half dozen computers that I used during the transcription and revising, over half a dozen years, to a flash drive, and finally to this website. Any mistakes in the text are my responsibility. (For instance, some of these half dozen computers seem to have different styles of lettering for the same named font. Go figure!)

Malcolm McAfee has been a continual source of support and inspiration. Many coffeehouse napkins have been consumed in our discussion notes, plans, and diagrams. Malcolm is one of the founders of PAIDEIA. He has maintained this vision throughout a multitude of changes over the years. PAIDEIA itself has developed into a network of research institutes that also include SCHOOL OF JOURNEYS, SCHOOL ON BOARDERS: a GLOBAL NETWORK: www.borderstudiesassociates.net.

Joline Whiteneck has continued to be my inspiration and advisor as well as my two sons, James and Ben. They all keep me both grounded and slightly ahead of myself, hopefully developing and evolving.

INTRODUCTION

Observing the Group, we are studying one of the most potent experiences in human existence—that is if we are studying the true Group. The word ‘group’ is bandied about so much! We can use this word for a conglomeration of objects that we perceive to have a rough relationship to one another. I have been amused how often I have come across books entitled something to the effect of The Theory of Groups in the psychology or sociology section of a bookstore. I open the book to see what it has to say and find a mathematical text. This is only a tangent to the Group that I am writing about.

This difference may be further illustrated. Imagine ourselves traveling on a wilderness plain. In the distance there are six people standing in a circle facing one another. From our vantage-point they resemble Stonehenge: imposing vertical figures standing out from the background, seemingly connected to one another, yet separate.

Outside the lights were shining on the river of tears,

I walked in from the distance with the music in my ears.

-from Bob Dylan, Went to See the Gypsy

The music that we hear is people talking. The air within the circle is charged, almost glowing. These people could be sitting around a campfire, in the dark of night, telling ancient stories, each person in turn. Or they may be involved in a frenzied debate, everyone bubbling over with ideas, barely allowing or getting in a word edgewise. It seems that they cannot possibly understand or hear one another, yet they respond swiftly—sometimes wildly—with high energy, humor, and friendship.

We are getting closer to the Group.

The circle people turn to look at us, slightly puzzled. The two closest people part and open the circle. One beckons. Another smiles. We feel a certain relief but also a bit of apprehension. We take the several steps necessary and become part of the circle making the number eight. Everyone sits down, pulling up a comfortable rock or log. The Group members turn toward us asking our names and introducing theirs. They inquire who we are and a little of what we are about. They seem genuinely interested.

Only now are we beginning to find out about a Group. The Group is a transformation. But not only one—it is a series of transformations. Webster defines transformation as:

...an act or instance of being changed completely or essentially in structure or composition.

Examples that are included in the dictionary entry:

In the earliest times transformations were common, and there was apparently no real line between animal and human...transformation of policy into law...transformation of man’s nature in Christ.

Webster 3rd International Dictionary (240) ^{1 (notes @ end of chapter)}

Of late profound personality change has been somewhat confused with altered states of consciousness. We are looking toward transformations of greater substance.² We may suddenly see the world and ourselves differently, just as suddenly returning to our ‘normal’ life. This is only a first hint of the process! Transformation is slow, like growth—indeed it is growth. More profound than the flip-flops of sudden enlightenment, also like growth, transformation comes in fits and spurts, involving repeated experience, practice, and discipline. The sudden flash of insight may certainly be part of the experience, but it is not its all or even primary goal.

This study is about the Transformation in the Group. True to the title, we find that this transformation refers to a change of an individual member of the Group and a change in all members of the Group together. The transformation is both.

If we could watch a transformation in the Group, showing the action in very slow motion, we would see a sequence that resembles the following:

We sit in the circle. Nobody is speaking.

We look intently at one another.

There is a feeling of impasse.

Suddenly one person comes forth with a statement.

It is a catalyst.

Everybody breathes a certain relief and conversation spontaneously erupts.

One person’s change becomes the Group’s. The Group’s change becomes each member’s change. The process may be reversed:

A Group member is very upset, crying.

The Group takes the member’s hand.

Another member agrees: “Yes, this is very hard. There doesn’t seem to be any way to handle the problem.”

The crying continues.

The Group takes the person, picking them up and cradling them between six people, three on each side.

Rocking, rocking.

The crying becomes sobs.

After a few minutes the rockee stands up, thanks the rockers, and sits down in the circle.

Later the rockee discusses possible options in light of the problem.

We are coming closer to the Group.

In this study there is much attention given to the determination of what a Group is and, then, what a Group does. In certain ways this is misleading. The Group can only be known thoroughly through the experience of Group membership. Even then, this knowledge is transitory and growing as the Group has a constant dynamic quality. I have attempted to portray as much of this elan as possible.

We will confront various theories and ideas, many different perspectives and viewpoints. This experience is similar to Group membership; the ideas of each member contribute to the texture of the whole. Perspectives that you don’t expect or anticipate enlarge your own!

I have quoted various theorists, group researchers, and experimenters at length as it is only possible to understand the transformation if we can experience the effect of the development of their ideas upon us.

The real organic process of the Group takes place when we start to notice that certain themes emerge then disappear, temporarily, only to re-emerge again later in discussion, from another speaker’s point-of-view, often rephrased and reworded. This is the essence of Group process and the interplay that leads to transformation.

We will disagree with some ideas. We may even think that there are some that are downright crazy. We may feel attracted to other viewpoints. For the study of the Group let us find common threads before we reject or applaud.

Once a sense of Group membership begins to be shared, themes regarding our common social experience enter the conversation. David Riesman, in his classic study of social affinity and alienation, The Lonely Crowd (189), has delineated several characterizable types of people: personalities arising in response to a society’s socioeconomic development. Wallace McAfee often refes to Riesman’s study while emphasizing difficulties individuals face dealing with what may be called social identity. These different personality types include the Tradition Directed Personality, the Inner Directed Personality, the Other Directed Personality, as well as the anomic or alienated person, and finally, the autonomous person which Riesman casts in an optimistic light.

The Tradition Directed Person is the dominant character of members of primitive social orders. There is a high socioeconomic growth potential, but the population is small; high birth rates and high death rates keep community size in check. As factors contributing to the death rate are decreased, largely due to the effects of improved health and nutritional technologies, a transitional period of population growth is brought about. Society at this point is somewhat unstable and a new character comes to the fore: the Inner Directed Person. Riesman describes this person as having a point of view minimally influenced by surrounding society. He pictures the Inner Directed Person as guided by an internal gyroscope, set in motion by parental influence in childhood. Riesman describes the rugged individualist and industrialists of the 19th and early 20th Centuries as examples of this character type.

As population and socioeconomic growth peaks and re-stabilizes to resource and environmental limits, the third character type becomes the most prevalent: the Other Directed Person. This personality is very sensitive to the feelings of others. Riesman uses the metaphor of social radar; persons constantly scan the social environment to be aware that their behavior is approved and that they are adjusted to the social norms.

Our society certainly appears to be moving rapidly through the second stage and into the third. The Inner Directed Person is being replaced by the Outer Directed Person. An important question we must struggle with is whether we are all doomed to choose between these three positions and live out our lives as Other Directed with our personal radar scanning our peers; or we may involve ourselves in the acquisition-control-power games of the Inner Directed Personality.

The group, at first glance, seems as though it would be a fertile petri dish to culture Other Directed people. On the other hand, it is not unusual for people to reject Group participation out-right, seeing this as a threat to Inner Directed values that they were raised to uphold, these values far from the death knell in our society. ³

Marshall McLuhan, more recently characterizes the direction of our contemporary society as becoming a world-wide electronic tribe:

Ours is a brand-new world of allatonceness. “Time” has ceased,“space” has vanished. We have begun to structure the primordial feeling, the tribal emotions from which a few centuries of literacy divorced us.

The Medium is the Massage (153:6)

There are shadings of a new global Tradition Directed viewpoint here. However, an important question comes up at this point that will be stimulus for extensive discussion ahead: Does not each member of a tribe know each of the other members personally, as individuals?

Reisman does not limit the possibilities to these three types. He identifies individuals who develop in directions other than the normal social flow. He names these two other possibilities Anomie and Autonomy.

In each society those who do not conform to the characterological patterns of the adjusted may be either anomic or autonomous. Anomic is English for Durkheim’s Anomique (adjective anomie) meaning ruleless, ungoverned. My use of anomic, however, covers a wider range than Durkheim’s metaphor. It is virtually synonymous with maladjusted, a term I refrain from using because of its negative connotations; for there are some cultures where I would place a higher value on the anomic or maladjusted than on the adjusted...the anomic person tends to sabotage either himself or his society, probably both.

The Lonely Crowd (189:242)

Then we have a choice between adjustment within the three types, socio-pathology, madness, or individuation. Anomie is roughly defined as maladjustment, the word describing a person who has not incorporated the rules of society. The hope of the Autonomous Person is that he or she may influence others:

But in a large society such as the American there is room for disparities, and hence for individuals to chose different modes of reconciliation. In the upper-income strata in America, many of the pressures which individuals feel spring from their shared interpretations of what is necessary to get along. As soon as one or two in a group emancipate themselves from these interpretations, without their work or their world coming to an end, others, too, may find the courage to do so. In that case, character will change in consonance with the altered interpretations of conditions.

In asking where the one or two innovators may come from, we must remember that social character is not all of character. The individual is capable of more than his society usually asks of him, though it is not at all easy to determine this, since potentialities may be hidden not only from others but from the individual himself.

The Lonely Crowd (189:240-241)

Although Riesman is an astute, almost prophetic observer of the social scene, he fails to really grasp the implications of the Group. Certainly he describes trends that we can observe around us, trends that influence the Group to its depths. He does identify a dynamic that is important for our investigation. While he terms this process as “emancipate”, we may call it personal or social growth. The Group, however, is a much more broadly ranging experience. All are welcome to participate effectively, not only the economically privileged. Other Direction is a part of the Group but so is autonomy. Tradition certainly has an influence. Anomie and Inner Directed values are often expressed by members. It is a strange and potent mix where Group participants are not set on tracks, equipped with radar or gyroscopes, but encouraged and listened to by other members attempting to understand one another in all their autonomy, anomie, adjustment, or experiences not so easily categorized. In the end Riesman is describing The Lonely Crowd not the true Group. Like McLuhan he writes about mass culture and misses the internal workings, the relatedness we humans feel for one another.

Shortly after the publication of The Lonely Crowd, Paul Goodman published a book on a related topic. In Growing Up Absurd (83) Goodman focuses on the disaffected and alienated youth of the middle and late 1950s. In contrast to most established socio-cultural studies of the time, studies viewing these young people from a distance, he inquires about the ingredients of a society which would give rise to a basic aimless posture of a person coming to maturity. One of the problems he cites is the lack of membership in a personal community. Post World War II Britain also had similar movements of young people. This theme echoes the subject matter of Colin Wilson’s Outsider series, including Religion and the Rebel. Wilson, who vivadly describes the pressures experienced by the creative individual in the face of a conformist society, was the fountainhead of British Angry Young Men of the 1950s, somewhat equivalent to American Beats. Numerous novels and films were written and produced about “outsiders”, usually about alienated adolescents. Continuing Goodman’s descriptions of American culture:

Instead, the present tendency is to impose on the countryside a new corporation style altogether, in the form of shopping centers (=national chain supermarkets) on the highway. This works out disastrously for the communities, for these “centers” are not centers of villages, and there cease to be villages at all, simply family houses…
This is the end of a long process of disruption, for in any case the industry is gone, the men work in plants thirty miles away. It is possible to travel many miles even in New England and not see a single activity a man could make a living at, except automobile agencies and filling stations; not even a food store. The schools are too large and centralized. The families tend to move away frequently, but even while they are put, they are driving around. This does not make much community to grow up in.

In more primitive societies, a chief community activity is working together, thatching a roof, net fishing. But with us, precisely this co-operative labor, for instance the work in a factory, is removed from its community setting and emptied, by the relations of production, of any community spirit.

Places that have no shape have no face-to-face functioning, for the shape is the functioning community. The loveliness of so many hamlets in Europe is that they have shape and are built of local materials by local craft. Perhaps the people had to cluster to attend early masses. In Ireland, where they farm out the back door, the rows of thatched houses line both sides of a little street. In France, where men go off to the farms, there may be a square. In our own early New England villages, where congregational and political spirit was strong, there was a common green with public buildings, though the families lived scattered on farms they worked. There was the shape of a community with its economy, its crafts, and its ideas. The advantages of growing up in such a community in ones early years is evident. It is not family supervision, on which the physicians of juvenile delinquency are now laying such stress; quite the contrary! it is the family does not have to bare the burden of teaching the culture. In a community, everyone knows the child face to face. There is an easy grading of overlapping ages, right up to the adults who are going about their business in a going concern, and not paying too much attention to the children. A good city neighborhood works in the same way.

Growing Up Absurd (83:109-111)

Although this is only one of many disruptive trends Goodman identifies within American society, it is an important one for the study of small Groups. It is precisely this sense of community that the small Group may lend to its members. A Group may easily be a first person community made up of members who live within a geographic area whose population is well over a million people.

The sobering effect of both Riesman’s and Goodman’s studies is that they are still, over twenty years after publication (now half a century and counting! revised ed.), relevant to the society we see around us. This is reflected in the lines of folk-rock poetry:

people used to get together round a fire

fishes were cooked

songs were sung

moonlight used to

guide our way home in the dark

do you find it hard remembering

and still you people tell me

life is easy getting on with

but what i’ve got so far

s’nuff to be going on with

people tell me that it’s so

i don’t know anymore

i don’t know

people used to get together round a problem

eyes were looked at

tongues were true

people used to say how do you do

do you find it hard remembering

and still you people tell me

life is easy getting on with

but what i’ve got so far

s’nuff to be going on with

people tell me that it’s so

i don’t know anymore

i don’t know

people used to spend an hour making tea

easy easy was the rule

people used to pause to think and contemplate

he who hustled was the fool

and still you people tell me

life is easy to get on with

but what i’ve got so far

s’nuff to be going on with

people tell me such and such and so and so

i don’t know any more

i don’t know.

Donovan Leitch, People Used To

It is not so surprising that these expessions of social criticism are fresh today as we look back into our historical records. Over twenty-four centuries ago Greece was undergoing a transition from a democratic state, a culture we still consider to be a highly creative and experimental epoch, to one of a more centralized and, ultimately, military governmental structure. Plato recorded and elaborated on many discussions taking place at that time. These “dialogues” were between members of small groups of people. Although Socrates is often portrayed as the central character or the host and stimulator of these discussions, with other participants as passive listeners, I do not believe that it would be presumptuous to assume that much of the free flow and give-and-take of a Group discussion has been concentrated into brief summary statements. Ellenberger in his Discovery of the Unconscious (59:41) has traced the tradition of psychotherapeutic schools of the West (growing from philosophical gatherings searching for Truth, following Pythagorus’ Brotherhood) to the Academy which was established around these Socratic dialogues.

While Bach and Stoller (196:222) are given credit for the invention of the modern Marathon Group, in The Symposium Plato presents a record of a Group of Athenian intellectual friends that lasts the better part of the night. The topic is the nature of Love, highly relevant to Group formation. Each participant addresses the Group with his views. From the few comments between each presentation, we see that each participant is encouraged by the rest to excel in his speculations. (Yes, it was all men. Surprising that these guys thought that they could explain Love without women. Happily and healthily, women are welcome in our Group—encouraging other types of organization and communicational developmental qualities that don’t seem to surface as often in discussion by men alone. More of women’s perspectives to come.) There is criticism and competition but also joking and good humored encouragement in their comments. Many different perspectives and views of Love are presented: qualities, sources, generation, mythical views, and especially relevant beneficial effects for society and individuals. Plato credits and reports in detail all participants’ contributions to the development of the theme of the evening, while true to form, Plato emphasizes Socrates’ presentation as its culmination. If I dare to court the ridiculous by attempting to summarize Socrates’ conclusion in one sentence: The fulfillment of our Love through relations and affection with or to others makes us whole.

Today’s Human Potential Movement has developed the modern Marathon (interesting Greek name!) as an attempt to break down participants’ defenses and intellectual processes. In contrast, the rational Greeks end the discussion when the irrational forces break through in the form of drunken revelers. Only Socrates remains to talk with the intruders. (Thanks to William Barrett, Irrational Man, for pointing this out.) Unfortunately, Plato does not leave us a record of the contents of this conversation, but the night seems to come to an end when Socrates becomes the center of attention, a sort of cult of personality overwhelms the Group conversation, and finally a gay admirer (as we would now describe him) seems to corner Socrates, interfering with any other Group discussion.

The earliest Christians also emphasize the small Group, basing this tradition on meetings of Jesus with his twelve disciples and the ritual of communion. Their time was also one of general social dissatisfaction, even upheaval. In contrast to the earlier Greeks, members of these first Christian Groups practice the development of non-rational experiences, promoting beneficial and healthful effects. They also are more inclusive—men and women. The records which have been preserved of these meetings describe the cultivation of the experience of the Holy Spirit and include the cure of various afflicted individuals. While The Bible describes these works as miracles, modern students of the comparative studies of the practices of faith healing, psychotherapy, and psychosomatic medicine show that these profound individual changes can be understood to result from approaches similar to those developed in some types of modern psychotherapy. Leslie Weatherhead in Psychology, Religion, and Healing (239), and Jerome Frank, whose work we will study in more depth later [Persuasion and Healing, (53)] are examples of therapists and practioners who, along with literary essayist and researcher Norman Cousins describing the healing power of laughter The Anatomy of an Illness (43, 44) and Herbert Benson (15, 16) who studies the benefits of meditation, prayer, and “remembered health”, give extensive illustration of these relationships. ⁴

The early Christian community is described by the author of the Book of Acts:

They met constantly to hear the apostles teach, and to share the common life, to break bread, and to pray. A sense of awe was everywhere, and many marvels and signs were brought about through the apostles. All whose faith had drawn them together held everything in common: they would sell their property and possessions and make a general distribution as the need of each required. With one mind they kept up their daily attendance at the temple, and, breaking bread in private houses, shared their meals with unaffected joy, as they praised God and enjoyed the favor of the whole people. And day by day the Lord added to their number.

New English Bible, Acts 2:42-47

The dual emphasis on community organization with its binding rituals: the breaking of bread and communion, and the cathartic expression of feeling leading to ecstatic experience and a new improved life, influenced later small groups such as the Pietistic and Hasidic groups of the Nineteenth Century (11, 164, 197). Finally, this same pattern is found today as an important process in groups whose emphasis includes a healing transformation. ⁵

Unfortunately, most of the writings of the early Church focus on the exhortations and the sermons of the principal leaders as well as their tribulations. Our purposes would be better served by records of the meetings, how the members supported one another and even challenged each other, focusing once again on personal transformation within the Group. We can infer that the church grew rapidly and the small Group meetings were replaced by larger mass experiences ending the emphasis on the personal Group where each member was valued.

This shift from small groups to larger organized experiences with less personal emphasis seems to have happened a number of times in Western history. Mowrer writes that Confession originated in a small group setting. It was later shifted to a ritualized event complete with booth and secrecy (159:123). ⁶

On the other hand, modern group therapy seems to have developed in reverse order. Joseph H. Pratt is considered to be one of the founders of group therapy with his Tuberculosis Class. The goals of these classes were to instill hope and alleviate secondary symptoms for patients suffering from T. B. The treatment for this disease, early in the 20th century, was a long, uncertain convalescence that consisted of waiting in quarantine. Attitude, specifically hope, had a great deal of effect on the ultimate remission. The class included didactic lectures by the doctor to the patients, relaxation techniques, and testimonials by patients. After a number of years Pratt broke the audience up into smaller discussion groups. Many modern self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Recovery, Inc., Weight Watchers, etc. can trace their roots back to Pratt’s pioneering group treatment approach. Fields of psychosomatic and holistic medicine have been stimulated by this therapeutic outlook [Cf. Chapters by and about Pratt in Group Psychotherapy and Group Function, (196), and The New Group Therapies, (197)].

Transformation in the Group, then, is a study about the transformation that is potential of small groups. There are certain features of Groups and certain experiences in which members participate that lead to and is this transformation. The inquiry culminates with a description of a workshop series that I developed in which Group transformation is a central approach to learning a highly specialized interpersonal skill.

Part I is titled Foundations and consists of a detailed literature review focusing on Group transformation. At this point we have surveyed little clear data on what a Group is, whether it is several individuals and no more, a microcosm which reflects trends radiating throughout society, or an entity with unique properties of its own. The first section of Part I (Chapter 1 ) is the examination of theory regarding Group formation.

The second section of Part I ( Chapter 2 ) is a review of relevant clinical and research studies particularly emphasizing the processes of healthy change that may take place within a Group. The emphasis in this chapter is on the development of criteria to enable evaluation of our transformation and its benefits. The fear and anger some people express when confronted with the possibility of becoming members of a group should warn us that groups are not a priori healthy. The public awareness of cults whose members have participated in bizarre, destructive, and disastrous actions—often appearing almost mindless or entranced—both demonstrates the power of interpersonal dynamics that support group phenomena as well as the consequences when the direction is toward impersonal crowd control, domination, and violence rather than healthy growth. The research review bears these points out.

Part II is the Approach presenting certain theories, philosophies, and techniques which I have found to be effective in developing a Group transformation. In a broader sense, this section of the study represents my own training and subsequent experiences facilitating Group transformation. It is from the concepts and experience of the Approach that I develop the workshop described in the final two chapters of this study: the Application.

The first section of Part II (Chapter 3) is a report of the philosophy and theories of Dr. Wallace T. McAfee who, with his wife Edna McAfee, led a continuous Group from 1960 until his death in 1978. The McAfees had been missionaries in China in the 1920s for the Presbyterian Church. Later he served as pastor for several churches in the U. S., retiring in the late 1940s. Both trained for and practiced as licensed psychologists. I had training, supervision, and therapeutic experience with the McAfees over the course of eight years.

Chapter 4 concentrates on Psychodrama. This is an action oriented technique in which the philosophy and theory cited in Chapter 3 is practiced in the Group to allow members to apply the Group transformation to their lives beyond the Group. In many ways Psychodrama has the property of ritual which brings the energies of the Group to converge on particular social situations that are in certain ways difficult for members. Details of the Psychodramatic method reported in this chapter, following from the theory in Chapter 3, illustrate my own training with the McAfees as well as methods and techniques which I found to be effective in facilitating transformation in the Group—this during five years of experience in Group leadership at the Neuropsychiatric Unit of Long Beach Memorial Medical Center. In this time I led in-patient Groups, Family Groups composed of several in-patients with their families, and training Groups with staff.

Part III is a report of an Application of Group transformation. These chapters detail a six-week Crisis Intervention Workshop that I developed for staff training. Consequently I taught and led this workshop many times for staff members of the Psychiatric Unit and the Emergency Room at Long Beach Memorial Medical Center.

Crisis Intervention involves transformation as it involves more than just learning certain theories and rules about emotional crisis. Intervention counselors come to enter a crisis, experience it, and engage the client in the process of resolution. As such, we are undergoing not one experience among others but one that includes and ultimately transforms all others. The Group offers a particularly powerful environment to teach, learn, and practice these skills.

NOTES Introduction

1 Number in parentheses is reference numbers in Bibliography: (240) is Webster 3rd International Dictionary etc. If there is a colon, number to right refers to a specific page number. As an example: (153:6) is reference entry 153, McLuhan, Marshall and Fiore, Quentin. Medium is the Massage, a Catalogue of Affects. New York: Bantam, 1967. Page number is 6. (As of January, 2016 the reference numbers are inaccurate. I am in the process of reorganizing the Reference-Bibliography.)

2 Charles T. Tart in Altered States of Consciousness (219) has collected a wide variety of reports of methods and experiences. These include meditation, hypnosis, dreams, psychedelic states, bio-feedback, among others. Although these reports seem to involve ‘transformation’ of self and world, alone their temporariness lends them the property of isolation from the realm of continuing social experience. While they definitely may inspire change, they are often only introductions to lasting transformation. Erika Fromm, in a later follow-up study on these issues: “ The Nature of Hypnosis and Other Altered States of Consciousness: An Ego Psychological Point of View” (79) has described various applications to psychotherapy and educational procedures. She also describes the importance of continued practice for ongoing improvement.

3 Reviewing the situation in 2013 it appears that Riesman’s Inner Directed Personality has had a resurgence in the political-economic sphere of the United States and much of the Western world. The consequences of regression to previous developmental stages seems evident, when new directions are called for. 2016 update: The U. S. presidential race has seen a surprising number of candidates who meet the criteria in expression, if not actual life style, of this personality type. Note late 2016: Our ‘newly elected’ (by less than popular vote) President! This must show that this personality type is attractive to a sizeable minority of the populous of the U. S. On the other hand, an equally sizeable minority seem to be very unhappy and even fearful. Recently several people that I have talked with have reported apocalyptic themed dreams and, of course, many of the religious groups that support the new Prez emphasize the book of Revelations. Much more about social anxiety and ‘End Times Religion’ in the coming chapters. Riesman includes but underemphasizes environmental effects. Pivoting with these apocalyptic scenerios of the followers of the Inner Directed is understanding or denying (ignorance of) the science that demonstrates the effect of climate change on the development or decline of human culture, historically and in the present, but also and toward the future.

Riesman’s personality descriptions are brief introductory generalizations of a field that is extremely complex and often controversial. Personality theory is a foundation of clinical psychology for both diagnosis and evaluation of health. While the DSM of the APA (6) is the standard for description of psychiatric difficulties, a study done in the 1950s by Timothy Leary (as director of clinical research for Oakland Kaiser Hospital—before his rebirth as an acid-guru): Interpersonal Diagnosis of Personality (131), provides extremely detailed descriptions of 16 social interactional personality patterns. He arranges these 16 personality types in a circular, wheel-like pattern with 3 level descriptions of behavior for each type. Both socially constructive as well as problematic—pathological interpersonal expression of each type is described. As an example, the Managerial-Autocratic and the Competitve-Narcissistic have beneficial qualities for leadership and organization, but as disordered expression, they become dictatorial and authoritarian. The types across the wheel are complimentary; they “pull” their opposites, in this case Self-Effacing Masochist and Docile-Dependent, respectively. These people become followers. In a healthy society they realize the goals of the leaders, but in the case of disorder they approach becoming the mob or an unquestioning militancy. Many studies of the authoritarian personality were done after the Second World War when awareness of the extreme destructive demands of Hilter and even our ally Stalin which included the atrocities and holocaust as they became public knowledge. It is not only the authoritarian leader, but the unquestioning followers that bring, what I term, the psuedo-group experience to grief. Riesman seems to have summarized the Managerial-Autocratic and the Competitive-Narcissistic qualities in his Inner Directed Personality. He does not describe the multitude of followers. Some Outer Directed Personalities may fit into this category, but many respond to one another—the crowd that will be described in chapter 1—not only the managerial type. Review of the American Psychiatric Association’s Diagnostis and Statistics Manuel (6) brings a question: What happened to the Authoritarian-Autocratic Personality who encourages so much social difficulty and disaster? Americans don’t like this guy (usually a guy), so we ignore him? This theme will weave itself throughout this study.

4 The Greeks also had ecstatic traditions expressed in their dramas and their various cults. The bacchanal or Dionysian Mysteries and the Elusinian Mysteries were the most popular, both agricultural themes (as were Jesus’ teaching stories a few centuries later). The former cult centered on Bacchus, also named Dionysus, who was the god of the vineyard, wine, revelry, creativity, and “the exceptional” [Walter Burkert: Greek Religion (23:161-167)]. His admirers would enter into an ecstatic state similar to what we may describe today as a ‘rave’, only more extreme and violent. This may have been induced by wine and entheogenic fungi or herbs from native grasses, but often by only sustained dancing and singing, probably accompanied by verbal agitation and invocation—recitation of the legened. There were many variations on this cult throughout Greece at different times. In its most extreme form, women would work themselves into a frenzy, tear live animals apart, and devour them, in acting out the myth where Dionysus, himself, is torn apart and devoured by these his devotees. There are even stories of these ‘maenads’ dismembering a local king. This ‘group’ activity appears to be an example of mob mentality and was, if anything, an example of a destructive psuedo-group. These activities were reflections of some of the tales about Dionysus and later, Orpheus. [Cf. Edith Hamilton’s Mythology (93) and Bullfinch’s Mythology: The Greek Myths (24)]. In contrast, the Eleusinian Mysteries possibly also used psychedelic-like substances with elaborate sacred ritual, considered to be a once-in-a-lifetime beneficial experience. Many of the luminaries of Hellenic Greece: artists, sculptors, dramatists, writers, philosophers, scientists, mathematicians, and politicians, participated in them. The Eleusinian Mysteries continued to be celebrated for many centuries and were so hallowed and important that they were never fully publicly revealed. The Mysteries, along with annual local festivals, were celebration in honor of Demeter, the goddess of agriculture. Her story (and ours) is entwined with the fate of her daughter Persephone, who was abducted and married by Hades, one of the three principle brothers, the most powerful patriarchal deities, he being the ruler of the sphere of the dead that bares his name. When Persephone was first abducted, Demeter went into an extreme mourning reaction and all life on earth began to wilt and die. The tale describes the devastation in gruesome detail. Zeus, the eldest ruling brother and the most generally powerful, interceded to save the human race. He is often referred to as Father Zeus, humankind’s protector and benefactor. Hades was allowed to claim his wife during a third of the year and we experience Demeter’s sadness at this loss: late Fall and Winter. In contrast, she celebrates her daughter’s return with the Spring! These Mysteries and festivals celebrate and honor Demeter and Persephone’s reunion from the underworld with the profusion of life that seems restored at this time of year; this reunion symbolic of the joy of the Spring—also celebrated as a rebirth. The local festivals also celebrate the harvest in the Fall. They did not take place in a small group environment. The one known attempt to reproduce the Mysteries in a small group by an individual with his friends ended in scandal. {R. Gordon Wasson, Albert Hofmann, and Charles Ruck research the true mystery of the Eleusinian ritual. [The Road to Eleusius (229)].} Carol Gilligan summarizes the Mysteries with a feminist perspective [In a Different Voice (81)]. Bertrand Russell discusses Dionysian and Orphic cults, their place in the development of classical Greek thought, influencing and promoting the development of philosophy and science. In his survey of such a rational pursuit as philosophy, Russell emphasizes the ecstatic experience as a source of insight and creativity. [History of Western Philosophy (201:13-20)]. In his follow-up illustrated coffee table! history of western philosophy Wisdom of the West Russell describes the influence of science and mysticism on one another: “Nietzsche called these two elements the Apollonian and the Dionysiac. Neither alone could have brought forth the extraordinary explosion of Greek culture... serenity on its own is just as incapable as mysticism, of causing an intellectual revolution...What is needed is a passionate search for truth and beauty... A lively curiosity, bent on passionate yet disinterested inquiry, this is what gives the ancient Greeks their place in history” (202:13). The Nietschean dialectic: Apollonian and Dionysiac, continues to find its way in interesting applications in the 20th century. Ruth Benedict bases her anthropological cultural description on these as organizational types in her Patterns of Culture (15). Gregory Bateson who is a major source for therapeutic perspective in the upcoming chapters, cites Benedict as an inspiring developmental influence on himself and fellow anthropologist-wife Margaret Mead (in Berger, Milton M. ed., Beyond the Double Bind: Communication and Family Systems, Theories, and Techniques with Schizophrenics (18). Spiegel and Spiegel Trance and Treatment: Clinical Use of Hypnosis identify the Apollonian and Dionysian as extreme polarities in styles of entrance into hypnotic trance. They develop a third that they name Odyssean which is somewhat of a blend or medium but also more practical and common. Most of us fall into this range with individual, selective use of the other two more extreme styles when needed or desired. Apollonians tend to be very concrete, logical, even skeptical, while Dionysians participate whole-heatedly. (Interesting Freudian-mistype! ‘Whole-heartedly’ was, of course, what my conscious mind was thinking.) Imagery, symbolic myth, poetry, story and belief are part of the Dionysian style. Suggestion may be tailored to an individual’s style, or even sometimes, to how he or she is feeling at a particular time (214).

The development of Christian ecstatic tradition was probably influenced by these Greek ceremonies according to studies done by classicists such as Friedrich Nietzsche (The Birth of Tragedy); Kiroly Kerenyi and Carl Jung (Science of Mythology); Joseph Campbell (Masks of God: Vol. I); Ernst Cassirer (The Myth of the State); and Mircea Eliade (Image and Symbol). Both of the Greek cults mentioned above as well as later cults centered on Orpheus were expressions of individuals, some considered divine some semi-divine, who descended and spent time in Hades then returned to our world. Even Homer told of Odysseus being required to journey to Hades before he could return home. These heros had mixed success in their journeys to the underworld. Joline and I have watched and often discuss Jean Cocteau’s amazing film Orpheus. Jung and his allies see an allegory of the psychotherapeutic process in these archetypal stories, the basic pattern of which is not exclusively localized to Greece or the Mediterranean area but is recounted in the many hero and trickster tales of cultures throughout the world {Carl Jung [Man and His Symbols (116), Two Essays on Analytic Psychology (114)]}. Medical anthropologist Melvin Konner, who has a very intimate experience with the !Kung San of the Kalahari Desert, demonstrates connection of trance-dance ritual to shamanic healing ceremony [Why the Reckless Survive...and Other Secrets of Human Nature (121)]. An internet viewable video of this ritual is available on Bizarre Foods with Andrew Zimmern; Travel Channel (254). In Chapter 1 this study and the video will be referred to again as example of the initiation of Group mind.

5 Cf. Chapter 1, Part 3, sections about Frank’s and Odum’s studies for discussion of certain parallels between modern encounter groups and Protestant Pietistic and Jewish Hasidic groups. Chapter 4 of this study includes a discussion of Catharsis and its relationship to emotional healing, both ancient and modern. Alfred North Whitehead comments on the relationship of ritual to emotion in Religion in the Making (244:21): “Ritual goes back beyond the dawn of history. It can be discerned in the animals, in their individual habits, and still more in their collective evolutions...emotion waits upon ritual; and then ritual is repeated and elaborated for the sake of attendant emotions. Mankind became artists in ritual...”

6 Studies in the sociology of religion show that there is a common progression from leader centered small groups to a schism among the close followers of the original leader. Each of these second generation leaders often claim to be the ‘true’ disciple of the original leader. These groups often ‘progress’ to a larger less personal organization. Anselm Wach: Sociology of Religion (227:39-40), describes a continuous dynamic between small groups with a more personal focus and the larger religious organizations whose members number in the thousands or even millions: “As a more elaborate and complicated system of cultic practices develops, the expanding need for experts leads to a reservation in principle or in practice of certain cultic acts and to the formation of a body of functionaries who take over and in fact monopolize certain activities in the cult... Private and public cultus ...symbolize the unity of life in city-states.” Freud’s Group Psychology and Analysis of the Ego (73) studies the group psychodynamics of this process, relating it to Love and the dialectical relationship to the violent expressions of introjection and incorporation represented by many rituals such as the cult of Dionysus mentioned above, this being a mythic representation of canabalism and human sacrifice which even surface in modern religious practices. The control of this potential violence is the cement with which civilization is built. Freud’s perspective toward groups will be reviewed in Chapter 1.

I. FOUNDATIONS

CHAPTER ONE REVIEWS THEORETICAL OUTLOOKS

TOWARD THE GROUP. THESE VIEWPOINTS ARE THE FOUNDATION

OF GROUP FORMATION AND TRANSFORMATION.

CHAPTER TWO IS A REVIEW OF CLINICAL RESEARCH

INDICATING THE NECESSARY PROPERTIES OF A GROUP ENVIRONMENT

PROMOTING A HEALTHY TRANSFORMATION.

Two inseparable sides of this self affirmation are distinguished:

CLINICAL AND RESEARCH EVIDENCE

2H2 + 02 → 2H2 O + Heat

Encounter Groups: First Facts (136:475-476)

Encounter Groups: First Facts (136:472-473)

Theory and Practice of Group Psychotherapy (254:476)

QUALITIES OF GROUP EXPERIENCE LEADING TO POSITIVE (HEALTHFUL) CHANGE

Four different leadership functions were identified by factor analysis:

1. Emotional Stimulation (challenging, confronting activity; intrusive modeling by personal risk-taking and high self-disclosure).

2. Caring (offering support, affection, praise, protection, warmth, acceptance, genuineness, concern).

3. Meaning Attribution (explaining, clarifying, interpreting, providing cognitive framework for change; translating feelings and experience into ideas).

4. Executive Function (setting limits, rules, norms, goals; managing time; pacing, stopping, interceding, suggesting procedures).

Theory and Practice of Group Therapy (254:477).

Outcomes measuring success or failure were then factored for each group. These frequencies were compared to the “leadership functions” by which the groups were conducted.

It was found that Caring and Meaning Attribution relate directly to outcome. In other words, leaders who exhibit these behaviors in their styles of leading had the most positive outcomes in their groups. They also had few Negative Changers. This result was especially pronounced when both factors were present and the positive outcome increased as frequency of the factors increased (253 :235-239).

Emotional Stimulation and Executive Function are important to outcome also, but these factors must be maintained at an optimal level, which seems to be a medium intensity. Too much or too little lowers their effectiveness (253:235-239).

The most successful leader, then, was the one moderate in amount of emotional stimulation and an expression of executive function and high in caring and meaning attribution. Both caring and meaning attribution seemed critical, but neither, alone, was sufficient to insure success.

Theory and Practice of Group Psychotherapy (254:477)

…the less effective leaders would be those who are very low or very high in stimulation, low in caring, do very little meaning attribution, and display too little or too much executive behavior.

Encounter Groups: First Facts (136:240)

In light of this discussion of effectiveness of leaders, it is interesting to note that of the two tape led groups, # 16 had a slightly negative effect, while the other, #17, was the second most successful group of the seventeen.

Group #16 (Tape) members showed decreased adequacy in coping, decreased need for affection from others, and a decreased tendency to view others as lenient.

Group # 17 (Tape) stands in sharp contrast to the previous tape group. Members of this group increased values focusing on the self, increased in the their sense of adequate or active coping strategies, viewed themselves as more lenient, and perceived the environment as offering increased opportunities for open peer communication.

Encounter Groups: First Facts (136:128)

While the unsuccessful group was characterized as: “Obedient, responsible, low conflict, cautious here-and-now programmed warmth and support” (136:87), the more successful tape group is described as follows:

Group #17 was considerably different from the other tape group. It was far less placid; the members more often expressed their dissatisfaction with the tape recorder. They would refer to the tape program as “George” in jocular ridiculing fashion. When the tape program suggested, for instance, that they do a certain exercise, someone would interrupt to say, “Oh, that’s a great idea, George.” In the last three meetings, the group played the tape all the way through at the beginning of the meeting, and decided whether of not there was any part of the taped instructions they wished to follow for the day. This was counter to basic instructions, which were to play the tape and follow its own instructions about when it should be turned off and on during the meeting.

Encounter Groups: First Facts (136:89)

We will return to comment on these Tape Led Groups at the end of this chapter.

In summarizing the characteristics of leadership for a successful group, Yalom states:

…we obtained surprising results which disconfirmed many of the current stereotypes about the prime ingredients of the successful encounter group experience. Although emotional experiences (expression and experiencing of strong affect, self-disclosure, giving and receiving feedback) were considered extremely important, they did not differentiate between successful and unsuccessful group members. In other words, the members who were unchanged or even had destructive experiences were as apt as successful members to value highly emotional incidents of the group.
What types of experiences did differentiate the successful from the unsuccessful members? There was very clear evidence that a cognitive component was essential; the successful members either acquired information or personal insight. That these findings occur in groups led by leaders who did not attach much importance to the intellectual component speaks strongly for their being part of the core, and not the facade, of the change process.

Theory and Practice of Group Psychotherapy (253:29)

This research, then, returning to my four levels of change discussed at the beginning of this chapter, indicates that these encounter groups affected the participants strongly on the level of Attitude. Over two-thirds of the participants felt that they had had an interesting and successful experience. For a change in the deeper levels of Values and Emotions to take place in a manner helpful to the participants in a group, there must be understanding, caring, and a balance intensity of both emotional expression and structure.
         There is an enigma or contradiction in these statistics. The percentages of people who reported that they had had a successful experience is significantly higher than the percentages of successes that were indicated by the more objective test scores and observations. There are probably several factors that contribute to these variances. A student who signs up and completes a course, or even takes a course for the experience or class credit, may find it interesting and stimulating but not change significantly in the process. If a person becomes a member of a therapy group, on the other hand, and remains unchanged after a time (I am not specifying what is a reasonable amount of time.), this experience may be regarded as a failure considering the outlay of resources that is meant to lead to an improved life experience, and especially the mitigation of continued suffering that should be addressed in an immediate fashion.
         In a more ominous tone, this discrepency between perceived success and objectively measured success indicates that members of groups may ignore or overlook harmful effects due to a type of group contagion [Cf. Le Bon and McDougal references in Freud: Group Psychology and Analysis of the Ego, cited above in Chapter 1. Jung may even consider this process to be a type of “possession”. Jung is highly skeptical of a group’s therapeutic potential in general. Cf. his critical essays in Group Psychotherapy and Group Function (169)]. Consciously, group participants may remain interested or engaged while the process may not be to their benefit. This is one of the reasons that I return to the issue of a healthy group environment so often.
         Finally, people join groups for many different motives and may derive benefits in other areas that therapy and related research may not recognize or are too difficult to measure. My purpose in looking at ingredients for a healthy change is to emphasize those aspects that can be identified and accentuated.

We may now extrapolate our information gained from this research. Our descriptions of four factors contributing to positive outcomes in the Groups have been presented in terms of leadership function. Using characteristics of a successful Group leader, as identified by Liebermann, Yalom, and Miles, we may describe the tone or optimal Group environment in which beneficial change occurs. The encounter Group research focuses primarily on these characteristics and behavior of the leaders. For our purposes, I will change the style of the research reports slightly. From the original reports of leader behaviors I will take the liberty of extrapolating the tone of the Group with a beneficial environment for members. I refer specifically to the leaders only where it would be impossible or too complex to describe certain qualities in terms of Group environment.

As Caring within the Group increases, beneficial effectiveness increases. Group members offer one another: “…friendship, love, affection, and frequent invitations...to seek feedback as well as support, praise, and encouragement.” Specific, definable, personal relationships are established. Such adjectives as: giving, understanding, genuineness, caring, sympathy, warmth, openness, kindness are associated with this factor. A technical orientation is negatively associated to a Group with a highly caring environment (136:238). I would add, from my observations while leading Groups, that the experience of members providing Caring to other Group members has an important therapeutic value for provider as well as recipient.

Meaning Attribution involves cognitizing behavior and is also directly, linearly related to outcome. Members of a Group, while gaining in understanding also derive beneficial effects from their Group experience. Group members develop concepts and understanding about the Group process, their relationships to other members, and their own experiences. Understanding, explaining, clarifying, and interpreting, provide frameworks for change. Members look directly into experience to understand its meaning, and the feelings involved. Discussion such as interpretation or even simple observation of one another’s behavior and attitude takes place leading to reflective insight. Liebermann, Yalom, and Miles find that this factor has a dual property. Members learn about aspects of the Group along with insights about themselves as individuals:

…interpretations generally focus on the group as a whole emphasize cognitive recognition of group climate, how the group is working, and so forth. (Issues are) often raise(d)…or…the group (is asked) to reflect on its behavior—to take a cognitive or reflective stance toward group experiences…(Groups) who are high on Meaning-Attribution directed at individual behavior request a similar stance relative to interpersonal issues.

Encounter Groups: First Facts (136:238)

Members of the Group focus on the process of understanding who we are, what we do, how we interact, and how we feel. Behavior and feelings become better understood: individually, interpersonally, as well as relating to Group process. The Group experience is most fruitful if there is a trend from relative Group chaos toward understanding of clearly defined models of Group process for Group members. Group members discuss interaction and share the experiences of Group membership with one another. Interpersonal communications principles are discussed, practiced, and applied to interactions in the Group. Individuals may work on personal therapy issues within the Group with the help of other Group members. Insights about both one’s self and Group interaction are examples of the type of Meaning Attribution that is associated with positive therapeutic change.

The perception of members that leaders who do not assume this function are more like peers suggests the quality of parent, priest, or pedagogue may be associated with this dimension. Meaning-Attribution, however, does not have the emotional valence of charisma as seen from the leaders’ scores…where charisma is clearly on a separate dimension.

Encounter Groups: First Facts (136:238-239)

Group members find the conversation interesting, stimulating, and often challenging. There must be optimal level of Emotional Stimulation which is effective for the encouragement of constructive change. If the Group offers members too little of this factor lethargy takes over. If the Group is too highly charged, the process freezes with an overload of anxiety or anger and rage, although anger may be worked with directly as in Psychodrama or recognized as a source for direction of change as with Gus. Emotional Stimulation involves challenge, confrontation, and revelation of personal values, feelings, beliefs, and attitudes. Members are given a great deal of individual attention and are expected and encouraged to participate. There is a high level of exhortation, challenges toward release, risk taking, and self-revelation. Anger may be expressed but also warmth and love. Group process includes emotional release and risk taking. The emotionally stimulating leader is described as possessing charisma and may function as a model. (136:235-238). Group climate itself may have a special quality analogous to charisma for the members.

Group participation has a predictable structure, even though it can be surprising at times. Executive Function is also a characteristic that has a positive effect at an optimal level. While this factor is important for the maintenance of the Group, if overdone it can rigidify the process, stifling creativity and free expression. Group members set limits, suggesting or setting rules, norms, goals, managing time, stopping, blocking, interceding, managing direction of movement. Members invite participation. They question one another, suggest procedures for both the Group or the individual. Decision-making functions and problem solving procedures may be suggested. Release of emotion is encouraged. Actual emotional release is an example of Emotional Stimulation. In Groups high in Executive Function members ask one another to reflect on some action while other members of the Group interpret it. A Group high in Meaning-Attribution, on the other hand, encourage the individual who is the Group focus to interpret his or her own actions or reflect on their participation in Group process. Structured exercises and teacher orientation by the leader appears to lower Group effectiveness (136:239)—although in the Chapter 2 narrative accounts of the Groups [L, Y, & M (136:30)], Group #3 which was considered highly successful, also had a very high number of structured exercises, along with humor and fun. Both self reflection and accurate Group or leader interpretation of members’ behavior are therapeutically effective. (Cf. description of accurate empathy in the next section.) An individual developing insight about themselves seems to have increasing benefits while Group confrontation or interpretation is helpful to a point but then can become decreasingly beneficial. Sometimes insight or inspiration may have high emotional energy, and communication of rage in Psychodrama or “primal” expression leading to Catharsis is promotion of healthful change. Research regarding psychotherapy effectiveness later in this chapter, indicates expression of high emotion between members who know and trust one another may be better understood and accepted than between relative strangers. Executive Function also maintains a safe environment to discuss personal issues that a member may feel vulnerable to share. Although the rules of the Group may be scrutinized by members, they also uphold the communicational structure as understood. Confusion about rules may be a source of therapeutic work. ²

Liebermann, Yalom, and Miles provide us with a wealth of information by which we may infer a Group environment that supports beneficial change. One point that they make about their research is that it is not necessarily indicative of psychotherapy Groups. Although some of the leaders were practitioners of psychotherapy, the groups were short term, lasting an academic quarter, and the participants were ‘taking’ the groups for class credit. Motivation for therapy involves other factors such as alleviation of felt discomfort, confusion regarding social relations and behavior, improved emotional health, and wish for improved life functioning (a goal shared with education) and improved relations with others. Psychotherapeutic approaches include recognition of focal issues or symptoms. Therapy sometimes may include a therapeutic contract. Clients become aware of difficult behavioral-emotional issues that are discussed and efforts made to resolve. These may be very uncomfortsble and sometimes even dangerous. In the final analysis therapy looks toward helping Group members change significant elements of their lives and ‘life styles’. With this in mind, I will next review research findings regarding psychotherapy outcome. We can use similar procedures of extrapolation to determine a healthy Group environment. Although the emphasis is slightly different, many of the findings coincide closely with the encounter group research.

While there are many theories about the forces and processes that influence group members toward positive change, psychotherapy researchers Charles Truax and Robert Carkhuff [Toward Effective Counseling and Psychotherapy, (223)] cite a small number of studies indicating the actual effectiveness of group therapy, identifying features that promote positive change. They have, however, developed thorough reviews of psychotherapy research, its meaning in relation to different schools of therapy, and methodology leading to different approaches to the training of therapists. Although these researchers’ initial orientation is client-centered therapy, they have attempted to integrate other orientations including psychoanalytic, behavioral, trait-factor, vocational, and existential-humanistic theory and techniques. They present a number of comparisons between different schools and approaches to therapy, along with results of many surveys and questionairres to show how their “therapeutic ingrediants” relate favorably to many other approaches. The shortcoming in their studies, for our purposes, is that most of these studies are with individual therapy and only occasional studies of groups. Nevertheless, their findings are applicable to our purpose of establishing a beneficial group environment.
Truax and Carkhuff begin their review of research identifying the effectiveness of helpful activities in therapy with a challenge by Eysenck, a researcher who questions whether psychotherapy is effective at all (63:697-725). Eysenck compares the rates of improvement of a population of neurotic patients who have had treatment with a matched population of neurotic people who were placed on a waiting list. He finds both groups to improve similarly (now come to be known as ‘waiting list cure’). He summarizes his findings:

• When untreated neurotic control groups are compared with experimental groups of neurotic patients treated by psychotherapy, both groups recover to approximately the same extent.

• When soldiers who have suffered a neurotic breakdown and have not received psychotherapy are compared with soldiers who have received psychotherapy, the chances of the two groups returning to duty are approximately equal.

• When neurotic soldiers are separated from the service, their chances of recovery are not affected by their receiving or not receiving psychotherapy.

• Civilian neurotics who are treated by psychotherapy recover or improve to approximately the same extent as similar neurotics receiving no psychotherapy.

• Children suffering from emotional disorders treated by psychotherapy recover or improve to approximately the same extent as similar children not receiving psychotherapy.

• Neurotic patients treated by means of psychotherapy based on learning theory improve slightly more quickly.

• Neurotic patients treated by means of psychoanalytic psychotherapy do not improve more quickly than patients treated by means of eclectic therapy, and may improve less quickly when account is taken of the large proportion of patients breaking off treatment.

• With the single exception of the psychotherapeutic methods based on learning theory, results of published research…suggest that the therapeutic effects of psychotherapy are small or non-existent, and do not in any demonstrable way add to the non-specific effects of routine medical treatment, or to such events as occur in the patients’ everyday experience.

Handbook of Abnormal Psychology (63:719-720)

Eysenck finds that the only measurable advantage to a person’s participation in psychotherapy is the speed of recovery, and this faster recovery takes place only in therapy based on learning theory. Truax and Carkhuff begin their review of psychotherapy outcome initially citing several research reports showing little improvement. Next, in contrast, they compare these findings with research that demonstrates positive change (223:6-22). These studies include a number of different techniques and also clients with different focal issues. Their research shows different types of improvement, while Eysenck’s cited research focuses primarily on treatment of neurosis. Such issues as anxiety, substance abuse, school success, social functioning, and psychosis are addressed by the research that Truax and Carkhuff review. These approaches include different techniques of therapy, are more specifically designed for varied symptoms, and at least some yield positive results in contrast to Eysenck. One example of a specialized approach to therapy, described in detail in the next chapter, has been developed since Esyenck’s study, by Vietnam War veterans forming ‘rap Groups’ to help one another re-enter American society. While Eysenck’s research presumably referred to the 1940s and 1950s, i. e. post World War II, Robert Jay Lifton’s research follows methods and processes that these veterans have found to be helpful, that I summarize in Chapter Three, ahead. Lifton presents a particularly powerful Group process as it is composed of individuals who have had a common experience forming Groups with a sense of brotherhood (and, presumably more recently sisterhood)—helping one another through a sometimes life threatening situation. Focal issues are relatively homogeneous with very high levels of Empathy, combining Warmth and Meaning Attribution. This is an example of an updated approach which is more specific in its focus than Eysenck’s. Since the time of Lifton’s book the diagnosis of Post Traumatic Stress Disorder (PTSD) has been developed. ³ Truax and Carkhuff conclude:

...after a careful review of the relevant research literature, it now appears that Eysenck was essentially correct in saying that the average counseling and psychotherapy as is currently practiced does not result in average client improvement greater than that observed in clients who receive no special counseling or psychotherapeutic treatment. (This is in spite of Eysenck’s inclusion of questionable data and indiscriminate pooling of data from reports with divergent criterian for treatment outcome.) Frank (65) and others have noted that statistical studies consistently report that about two-thirds of the neurotic patients improve immediately after treatment regardless of the type of psychotherapy received, but that the same improvement rate has been found for comparable clients who have not had psychotherapy. However, some relatively well-controlled studies show that certain counselors or therapists do produce beneficial effects beyond that observed in equivalent control groups.

Toward Effective Counseling and Psychotherapy (223:5)

In other words, a highly skilled counselor or therapist can facilitate improvement for a significantly higher number of clients than the average, and average counseling and therapy is no better than none. Truax and Carkhuff combine this information to come to a startling conclusion:

Putting together these two bodies of evidence, it logically follows that if psychotherapy has no overall effect, but that there are valid specific instances where it is indeed effective, then there must also be specific instances in which it is harmful. That is, to achieve this average, if some clients have been helped, then other clients must have been harmed.

Toward Effective Counseling and Psychotherapy (223:5)

These results and interpretation are in substantial agreement with the statistical research that Liebermann, Yalom, and Miles find with their encounter group survey. (Also in agreement, both research findings included evidence that these respective approaches to individual change had another similar significant effect. Some participants were moved from the middle, ‘No Change’ position toward improvement, but also failure for others.) We conclude, then, that a group may have harmful as well as beneficial effects on its members. It is not difficult to find examples in the newspaper or on TV of ‘groups’ that have proceeded over time to questionable, if not outright destructive stances to themselves and society. Manson’s Family, the S. L. A., Jonestown, Heaven’s Gate, the list can continue for far too long. From the opposite side of the social-political sphere, Irvin Janis has studied Groupthink, the situation where administrative groups have virtually talked themselves into pursuing public policy that has had disastrous results. The members are not trying to improve their own perspective; usually in these instances, they assume their own infallibility (108). (END NOTE 11 includes some operational principles to improve and safeguard against this situation. I would also refer back to the footnote #1 of this chapter. It may be an issue of semantics, but a true Group should refer to a Group with beneficial effects for its members. Crowd, mob, or herd dynamics operate when members are depersonalized and led toward alienated and sometimes destructive ends.) For our study we may, once again, identify healthful, creative qualities promoted within a Group and replace the focus on the individual therapist to a focus on the Group environment. Truax and Carkhuff isolate and study these qualities that successful therapists promote in their sessions. Not surprisingly, considering their initial client-centered orientation, they have developed three “Central Therapeutic Ingredients” which appear to be very close to conditions recommended by Carl Rogers in Client Centered Therapy and his other published studies (190, 191, 193,194, 195). They do review studies from a number of other clinical researchers who also identify these or similar conditions to lead to success. They clarify definitions and greatly expand their applications to other schools of therapy and training. They have also produced scales and behavioral descriptions with which we may judge the beneficial effectiveness of therapeutic interactions. We will return to these scales for examples. (Client centered therapy, as a technique, is not given any special treatment in these research summaries. Practitioners of the technique have both success and mixed results.) ⁴

The three Central Therapeutic Ingredients of an effective counseling-therapeutic relationship are:

• Genuineness;

• Non-possessive Warmth;

• Accurate Empathy.

Truax and Carkhuff describe these therapeutic ingredients:

Genuineness (also referred to as ‘Congruence’) is a quality of interaction that describes honest communication. In genuine relationships, people generally say what they mean. There is a minimum of ulterior motive involved in the interaction. An attempt to lower facades is communicated. Defensiveness, rather than person-to-person interaction, is the antithesis of genuineness (223:23). Trust is a growing part of a genuine relationship.
Ethologists including Konrad Lorenz in his studies On Aggression (190, 191), Jane Goodall in her work with chimpanzees in the wild In the Shadow of Man (82), and originally Darwin, who developed the discipline in The Expression of Emotion in Man and Animals (47: 52-58, Chps. 2, 10, 12), have shown how posturing is indicative of fear or hostility. Often posturing is a method of establishing hierarchy and bullying. Jockeying for power may replace intimacy, although sometimes it may be a prelude to intimacy. Posturing as an initial interaction may develop into a more genuine communication. Gregory Bateson in Steps to an Ecology of Mind: “Theory of Play and Fantasy” (13), studies posturing as a developmental activity in which young animals learn to distinguish play from aggression. His focus is on the difference in the origins of ‘normal’ perception and perception and behavior of persons who have been diagnosed as suffering from schizophrenia. In the latter situation a patient has trouble distinguishing motives and meaning during communication with members of his or her immediate social group. Although ‘normal’ response to posturing may include mistrust or distaste, it does not result in mystification leading to dissociation and a radical misconstruing of others’ meanings and motives. Especially detrimental to a person suffering from a mental illness is the sense of self blame in response to The Double-Bind, discussed in more detail in later chapters.

Non-Possessive Warmth is similar to positive regard that Group members develop for one-another. In a Group with high levels of non-possessive warmth, members experience themselves as valued. Group members communicate an experience of love and being loved to one another. Members feel welcomed to the Group (223:34-38). Their ideas are welcomed and they feel that they contribute to Group process which may be both in the role of expressing concern, but also receiving others attention and concern.
          Warmth may be expressed actively as well as passively. In therapy or a Group with orientation toward growth there are expectations for improvement or change. These are processes that members develop together and work toward with each others’ assistance. Non-possessive warmth includes a positive set of values and concern for one another (222:34-38). Adler’s description of working toward an “ideal of ultimate values” through a “mild barrage of questions” cited in the previous chapter comes to mind as an example. Group members are concerned about one another, not hostile or overly competitive in their motives. Members communicate concern and care when a Group member is in someway ‘stuck’ or making poor judgments. They may be challenging and even confrontational when a member needs a boost or help toward self care or improved perspective. The ‘non-possessive’ aspect refers to the non-authoritarian climate. Although members disagree, they do not have to ‘fall into line’ to be a member. Competition and disagreement certainly have their place in a Group that values members’ development, even as in children’s gangs (in Cooley’s and Addam’s meaning), neighborhoods, or families as emphasized in the previous chapter. Members are accepted, however, no matter what their response. Often in therapy sessions clients are encouraged to express anything that comes to mind or to ‘free associate’. Anything that they talk about is accepted and discussed with the exception of threats of violence with the intention of action. Limitations include legally (and ethically), that therapists are required to report crimes against minors. Also, serious threats of self harm would not be ignored. Personal concern for one anothers’ safety and health would seem to be a summary response embodying all three Ingredients. Therapy results partially from a degree of tension: while the Group members accept one another ‘unconditionally’ they are also trying to improve themselves and each other. The accepting presence of other members may be support while a person works out issues themselves.
         While Warmth may be expressed unconditionally, the non-possessive aspect of this Ingredient is practiced with a balanced intensity. Practically, acceptence of a member’s behavior may have cetain limits. At one extreme, which we might call ‘possessive coldness’, a person is valued only for what he or she gives to another. This is a symbiotic interaction leading to exploitation. Economists write of people as ‘human capital’ or commodities, a type of depersonalization that promotes alienation and a sense of isolation. At the other extreme a person may be valued even when they engage in violent or destructive behavior. To accept antisocial behaviour unconditionally would be a type of license, not part of a healthy or therapeutic interaction. A. S. Neill, radical English educator, friend of Wilhelm Reich, uses a community model of responsibility and governance for his school Summerhill. Neil writes extensively about the difference between “freedom”, an experience promoting growth through personal responsibility, contrasting with “license”, a type of behavior with little responsibility toward others. While a student’s antisocial behavior is not accepted, and certain consequences may apply as in greater society, he or she is not rejected as a person [Summerhill (161)]. A student’s improvement may even be recognized. (This certainly expands the definition of unconditional acceptance, and may show there are certain debates in therapeutic literature. A particular treatment approach seems logical for a particular personality issue.)
         Client centered and psychoanalytic therapies often proceed in a “nondirective” or free association manner. Empathetic reflecting and accepting by the therapist allows the development of internal awareness as can be seen in recordings of Rogers’ counseling sessions (Carl Rogers and Gloria on www.YouTube.com). The many comic-cynical comments in Woody Allen films about analyses ending years or even centuries later (if ever) are the results we all laugh at (ha ha!). Complete acceptance of a client’s approach has its place with people with cognitive organization and internally directive reality testing. But! having provided the initial mental health interview for many psychotic patients (individuals who were unable to explain where they were or how they got there, or even who they were) and people with personality disorders [Axis II DMS (6) especially Narcissistic, Borderline, Schizophreniform and Anti-Social Disorders], as well as persons manifesting various organic brain syndromes resulting from medical side effects, chemical use or detox, even brain tumors (as was diagnosed in the E. R. where I sent them)—patients brought to the hospital or jail by police who are mainly interested in maintaining order and safety in the community, and my goal as a Crisis Intervention Counselor (see Chapter 6) to establish communication, evaluate the need of the client to be in the hospital or in a safe location in jail (if being arrested by police), with medical or psychiatric intervention, or safety and supports of friends or family if released, therapeutically helping them organize their thought and behavior, and plan for the next day or week, I have needed to structure the interview. While accepting them as a person, there are certain issues they must address such as: ‘Why did you end up here—having come on your own or having been brought in, often involuntarily?’ And: ‘Are you going to take care of yourself and deal with the immediate situation? How? If not, there are people who will. Some probably more to your liking than others. Here are your options right now. How can we get you to where you need to be?’ (see “Hazard” Chapter 6) Counseling, therapy, and crisis intervention is a mansion with many suites.

Empathy is central and necessary in healthy human communication. We do not understand one another unless we have some idea of what others are experiencing during conversation. Without sharing feeling or passion (empathy from the Greek: en pathos = with feeling or passion) we become mathematical, machine or computer-like. Too often, however, we accept a common, every day social level of empathy. We do not pay too much attention to what people say about their inner experiences, themselves, and their private worlds. Indeed, if we show too much interest we may be perceived as intrusive. This response would indicate that the person who we are addressing has mixed feelings about our motives. Various anthropologists and psychologist who have done work with non-European, non-Western cultures (Bateson, Benedict, Konner, Maslow, Erikson) cited in other parts of this study, show that different cultures understand and accept expression of emotion—some even expecting these responses which may be considered overly dramatic or even hysterical in the West. Without analyzing our own purposes and detailing an interpersonal phenomenology, this should underscore the need for accurate empathy as well as showing how warmth and genuineness are also needed. Truax and Carkhuff point out that accurate empathy has always been at the heart of therapy (222:39). Part of the reason that a client comes to therapy is that the therapist, as professional listener, gains and communicates back to the client a greater understanding of the client’s self than he or she experiences alone. This increased experience and sharing with another is part of the therapeutic process. In fact, a unique dimension of psychotherapy, both individual and Group, is empathy for experiences that may be uncomfortable or too sensitive to share in ‘normal’ discourse. In the Group all members ideally develop the ability to relate to what the other members experience. As this happens empathy is developed for us all. There is a sense of sharing our experience with each other. This can lead to a feeling of belonging and acceptance and promote encouragement toward developing and achieving goals of improvement and growth.
George Herbert Mead, describing “Development of Mind” and “Genesis of Self”, summarized in the previous chapter, shows how empathetic processes are necessary ingredients of the individual’s ability to choose, processes that Group members experience during healthful, therapeutic development and transformation. Mead’s description will be recapped as an example of empathetic communication and development: “When this occurs the individual becomes self-conscious and has a mind; he becomes aware of his relations to that process as a whole, and to the other individuals participating in it with him...aware of that process as modified by the reactions and interactions of individuals—including himself—who are carrying it on...which enables the individual to take the attitude of the other toward himself... ” and of the self: “The self is something which has a development... (it) arises in the process of social experience and activity...develops in the given individual as a result of his relations to that process as a whole and to other individuals within that process...” (italics added T. K. W.) (154:134).

Truax and Carkhuff have studied counseling and therapy sessions closely. They particularly concentrate on clinicians whose clients show beneficial changes while in or following a series of sessions. For training purposes, they devise scored scales to measure the effectiveness of client-therapist interaction. In these scales, the lowest number indicates virtually no therapeutic value and a high potential for harm. An increasing score indicates increasing therapeutic effectiveness. As with previous research reports I have taken the liberty to paraphrase and modify descriptions as Group interaction while the original descriptions were usually based on individual therapy sessions. I also add a few elaborations from my own clinical experience. Interactions are described at the lowest, medium, and highest effectiveness, omitting intermediate steps. The numbers of the stages correspond to the scale developed by Truax and Carkhuff.

Genuineness

Stage 1 – Group interaction is clearly defensive. What members say and what they do is not congruent. There may be a striking contradiction in voice qualities and non-verbal cues. (Examples may include defensive social games without awareness or concern for one another, or angry members ‘grilling’ a member ‘for their own good’ while their actual motives are to punish.)

Stage 3 – The meeting is formal and professional. Communication is forced and implicitly defensive. This is ‘normal’ business or public communication.

Stage 5 – Members interact freely and deeply. Communication is open. Feelings of all types are expressed and welcomed. Pleasant, painful, and contradictory feelings are attended to. The members communicate their inner experiences to one another.

Toward Effective Counseling and Psychotherapy (223:68-72)

Non-Possessive Warmth

Stage 1 – The Group members actively offer advice and direction to one another, giving clearly negative regard. The attitude is one of ‘...this is best for you.’ The Group members are highly judgmental and consider themselves ‘responsible for others who may be the center of attention. Thought reform and authoritarian ‘groups’ demand personal confession of members’ failings in adopting the ‘correct’ behavior or ideas. Members are required to ‘fall into line’ without concern for their individuality or personal issues. Other viewpoints expressed in this study would question whether this should even be decribed as a ‘group’.

Stage 3 – Group members communicate care and concern for one another but the tone of the group is ‘semi-possessive’ of the members. Communication indicates that it is important that members behave in a certain, expected manner. “We’re okay as long as we follow the rules with predictable behavior.” Once again, this is normal public ‘acceptable’ behavior, in fact it may be more personal than the average ‘norm’.

Stage 5 – Warmth without restriction is communicated between members. Each Group member experiences respect for rights of free choice and personal worth. Members feel free to be themselves even if they are regressing, being defensive or expressing dislike or rejection. Members freely share their joys and aspirations or their depressions and failures. Members enjoy one anothers’ fellowship. The Introduction ⁵ offers examples of such caring.

Toward Effective Counseling and Psychotherapy (223:58-68)

Necessary restrictions include a limiting of violence and an agreement of structure for the sake of communication. Obviously a Group would dissolve in chaos were all members, or even several, to regress or express rage all at once. Control, however, is administered in an attitude of regard, non-punitively. Psychodrama, the topic of Chapter 4, is also a method of structuring for more violent expression in a safe environment, with warmth as well as playfulness. This type of control cross references to Yalom, Lieberman, and Miles description of Executive Function.

Accurate Empathy

Stage 1 – Group members seem completely unaware of one another’s expressed feelings or at times even their presence. Response is not appropriate to the mood or content of statements. Members may appear bored, disinterested, or actively offering advice without taking account of response or receptiveness.

Stage 5 – Group members respond to more obviously expressed feelings and concepts. Although there is awareness of less obvious feelings, response tends to be inaccurate, mildly defensive, or of a probing or critical nature. Tone of communication is jarring and not completely satisfactory for participants. There may be misunderstanding or some confusion.

Stage 9 – Response is unerring in accuracy and intensity. There is no hesitation; understanding of the deepest emotion is communicated. Even as emotion and content shift, the entire Group functions together smoothly. Through the process, there is an expansion of understanding and elaboration of experience for Group members. Members feel encouraged to continue or ‘tell us more.’

Toward Effective Counseling and Psychotherapy (223:46-58)

The scales above demonstrate a Group process moving from little involvement or concern of members for one another, through a stage of common social communication, toward a full Group experience. In one of their few comments about Group therapy Truax and Carkhuff summarize the combination of these higher levels of Group experience under the title Group Cohesiveness. They cite research that indicates the presence of Group Cohesiveness to be crucial for members to change beneficially during their Group experience (223:119-120).

Group Cohesiveness, then, is a term that brings together the effects and interplay of the three Central Therapeutic Ingredients as they develop within a Group. We see that these three Central Ingredients are not independent entities but rather affect one another closely. The presence of a high level of one Ingredient promotes the development of others. As I was reframing the scale descriptions to illustrate Group climate, I found that as I described each seperate Ingredient, I often needed to refer to the other Ingredients.

I would summarize the qualities of communication that Truax and Carkhuff identify as leading to health promoting Group Cohesiveness: Members interact freely and deeply with open communication, expressing feelings of all types: positive, negative, pleasant, painful and often contradictory. Inner experiences are attended to and discussed in a warm accepting environment. Each Group member experiences respect for rights of free choice and personal worth, feels free to be themselves even if they are regressing, being defensive, or expressing dislike or rejection. Members freely share their joys and aspirations or their depressions and failures. Members enjoy one anothers’ fellowship. Communication is unerring in accuracy and intensity with no hesiatation. Understanding of the deepest emotion is communicated and as emotion and content shift, the entire Group functions together smoothly. Through the process, there is an expansion of understanding and elaboration of experience for Group members. Members feel encouraged to continue and ‘Tell us more.

To show the flux of these Ingredients and how they benefit Group members, I will return to our three personal case studies: Gus, Carla, and Allen.

When Gus was confronted by other members of the Group the interaction may easily have turned out badly. Because there was a high degree of Empathy that had been established in the Group, however, the confrontation was exactly the correct information and intensity to move Gus to reflect and attempt new, more socially oriented behavior in his life outside of the Group. If the level of Warmth had not been sufficient in the Group, Gus could have easily shrugged off the confrontation or become put-off by it; he could have left the Group. Both of these actions would have been the result of low Group Cohesiveness.
          Carla, on the other hand, did leave the Group for awhile at the suggestion and approval of the leader. This was a mutually agreed upon time-out due to the extreme stress and agitation that she experienced during Group sessions. This came to a head several weeks after she started attending the Group. Another student member seems to have been the explicit impetus for her leaving. Carla had related to the Group that she could not concentrate on her assignments. Whenever she sat down to study she started feeling so angry with a professor of one of her classes that she would involuntarily picture the instructor and start telling him what she thought of his assignment in very uncomplimentary terms. This rage would take over her concentration and interfere with her progress. She would also, during Group sessions, compulsively burst into vitriolic rants about students in her high school. Jan, a sophomore psychology major (Sometimes life imitates clinical cliches as well as art!), told Carla in what seemed to be a very concerned and personal manner, that her problems sounded like a case study of a patient who had been diagnosed with schizophrenia as presented in her, Jan’s, abnormal psychology course. Jan advised Carla to see a psychiatrist immediately. There was a good chance that she could be stabilized if not cured. The Group could superficially be rated high on Genuineness and Warmth. (Later, however, in Group discussion some issues of jealously and fear became more apparent in Jan’s motives.)
            Even Empathy has possibly been expressed at a higher level than may first have been obvious, considering Jan’s off-the-wall misdiagnosis. Carla had stated, in her first Group session, that she thought that she was schizophrenic, an equally amateur self-misdiagnosis. Occasionally, new participants in a group introduce themselves in overly dramatic, somewhat sarcastic terms like I’m schizophrenic! or I’m crazy as a loon! (Yes, I’ve heard this more than once, sometimes from members who have been at it awhile.) Usually this means that they feel somewhat disorganized, anxious, and extremely stressed-out, a common feeling for a person just beginning counseling. It is also possible that Carla was echoing a theme that was popular on campus at that time: that a schizophrenic episode leads to a transcendental experience and a type of enlightenment. Carla may have been identifying herself with this fad. In response, as Jan later explained, she was just trying to help Carla with this problem.
          Carla’s resulting panic was not at the thought of being mentally ill, as she discussed in subsequent private sessions, but at the idea of being in a situation with a man in absolute control of her life, particularly in a mental hospital with a male psychiatrist. These individual counseling sessions also included discussion about important confidential issues that were not discussed in the more public environment of Group. Jan had effectively zeroed in on some of Carla’s deeper fears, this focusing being a high degree of partial Empathy. Neither person really understood what had happened and the emotional explosion that followed Jan’s comments was a surprise to all concerned. Over the course of her individual counseling sessions Carla worked out some of these complicated interactions and responses. These centered on dominant males in her life, initially the professor, then the doctors, and even men she had dated, as well as her brothers and her father. These interpersonal issues combined with family expectations of academic achievement, which seemed to be hitting the wall. This situation was creating a great deal of stress in Carla’s life. (“Carla” is a composite of summaries given by counselors-in-training during supervision, while they counseled student clients, both male and female. The issues and interaction reported actually took place, by various counselees, in Group where these interns were co-therapists or during individual sessions.) Initially, Carla seemed only vaguely conscious of these pressures and dynamics. While she temporarily left the Group she continued to see a female counselor who began working with her on the sources of this stress. As I have indicated, she later returned to the Group with her counselor’s encouragement and without psychiatric intervention and only a minor disruption of her studies. It was noted by other members that she did not seem to become as agitated as she had become previously. Initially she would start obsessively talking about herself, possibly revealing too much about her inner experience, too quickly. Now she could sit quietly while other members talked. The one-to-one counseling continued while she resumed the Group. Her individual counselor concentrated on a certain set of Empathetic Qualities while the Group focused on others.
       Allen, in contrast, presents a very bare-bones approach to Group Cohesiveness. The Group he attends is not particularly high in Warmth, in fact at times it can appear rather critical and confrontational, even cruel. This may be hard to evaluate as it is largely made up of street-wise adolescents whose common language is always tinged with sarcasm and allusions to sex, drugs, violence, and, yes, rock and roll—these topics discussed especially in the presence of older adults and leaders, with sublimated, and often not so sublimated, anger in their direction. What appears harsh to an outsider may be a type of Empathy, the participants relating to one another’s life experiences. The main emphasis is on Genuineness. Life is described largely as a game, but Group members tell each other to “Drop all that bullshit and come clean.” Or, “Be real!” There is a framework of approach, within which the Group operates, based on Twelve-Step principles. As this structure and process has developed for treatment of alcohol and, later, drug abuse, it has what could be described as an internal wisdom, an Empathic Understanding summarizing the experience of members of A. A., then later N. A., over several decades. ⁶ Allen explains that he thinks this approach is a ‘game’ too, but it works in that it keeps him straight. Empathy, also in this case, means roughly seeing through other members’ rationalizations and telling them when they are using them. In the confrontation there seems to be an expression of understanding and concern. When Allen is depressed or angry, the other members will not let him withdraw or leave and take drugs. He does the same for them and recounting his experiences and successes helps him build his own strength and self worth.
         The Group culture that I have described, including the Twelve-Step approach, and even the brutal Genuineness contribute to an Empathetic Understanding shared by Allen and his Group. The quality of Executive Function, also identified from the Stanford research, is very important for disturbed adolescents. Rational and consistent limits and rules can even be seen as an expression of Empathy and Warmth, a type of expression of caring and concern. Around drug and alcohol use and physical violence, Executive Function, partially expressed in the form of “House Rules”, is quite absolute and unbending: alcohol, substance use, and physical and verbal threats or actions are not allowed. Sometimes anger boils over, but these are issues to be discussed in community meetings or Group sessions. Violation becomes focus for serious discussion and repeated violations may be a cause for restriction of privileges or even expulsion. Some group homes have even stricter policies. In this case this is therapeutically beneficial. Issues that residents have with these rules, which is a common and frequent theme for discussion in Group, are the basis of a therapeutic process of internalizing rational, healthy perspectives toward self-care. As was the case with Allen with his initial Group Home placement, these rules may also be imposed by outside authorities including juvenile probation and social welfare agencies. This situation provides a fruitful environment for the residents and staff to discuss ways to deal with anger and procedures to meet requirements imposed by impersonal forces, a fertile ground to learn self-care and self-control, leading to survival and responsibility in outside society. (Cf Fritz Redl, When We Deal With Children and Understanding Children’s Behavior (188).
         Residents of the half-way house where Allen lives can be observed showing interest and concern for each other on a daily basis during non-group interchanges and discussions. These day-to-day interactions can be high in therapeutic quality. Sometimes it appears that residents save their more dramatic interactions for the Group. This is a way of working on difficulties during Group time and practicing a more ‘normal’ life-style and interaction during residents’ free ‘living time’. This is one example of how a great deal more has taken place in the Groups of which Gus, Carla, and Allen were members, than the therapeutic change that I have focused on. Group members who were the basis for these case examples discussed and worked on family issues, interpersonal issues, universal and existential issues, developed a sense of hope, and Allen, especially, was given guidance, direction (sometimes more than he wanted), as well as education and tutoring by Group Home staff. I have concentrated on focal issues of each case study and this is an introduction to the next section of this chapter.

SUMMARY OF CLINICAL AND RESEARCH EVIDENCE

Yalom‘s Therapeutic Factors ⁷

Irvin Yalom organizes sections of his book, Theory and Practice of Group Psychotherapy (253:4), around eleven “Therapeutic Factors”. He sees these as descriptions of important dynamic qualities that take place in therapy groups. These “Factors” are:

• Installation of Hope.

• Universality.

• Imparting Information.

• Altruism.

• Corrective Recapitulation of the Primary Family Group.

• Development of Socializing Techniques.

• Imitative Behavior.

• Interpersonal Learning.

• Group Cohesiveness.

• Catharsis.

• Existential Factors.

Although Yalom originally developed these “Factors” for therapy groups, their significance has wider application. Virtually all of these “Factors” are potentially present in any small group. While we attend to and focus on these “Factors” in therapy, they all exist in many other groups active in our communities and even our work. These groups, of which we are all members, are not specifically designated as therapeutic but certainly benefit, in important, meaningful ways, to our lives. Group membership, then, may contribute an unrecognized therapeutic effect regardless of the rationale for the group. With the present interest in community mental health, we should recognize that many types of groups have prophylactic as well as creative-developmental benefits for participants. (This is a point that Wallace McAfee and I came to as we discussed this recently published research.)

In this section these “Therapeutic Factors” are correlated with organizing points that have been emphasized in the theories and clinical research of this and the previous chapter:

The theories of Freud, Fromm, Tillich, and Adler are reviewed to gain insight into social formations which are present in a group but yet extend to larger social organization. Freud emphasizes relationships with authority particularly Recapitulation of the Primary Family Group. He does not emphasize the small group in itself, but sees each member of a group as being held in tension or “identification” with the leader. The structure of the group reflects deeper unconscious motives including potential for violence—this maintained under control. In this organization Universality, Imparting of Information, Imitative Behavior, and limited type of Group Cohesiveness, focusing on the leader, all are present. Indeed, some psychoanalysts believe that therapeutic benefit comes only from members’ relationships with the leader and consequently de-emphasize member-to-member relationships. ⁸ Other psychoanalysts, notably Bion (20:166), see this as an avoidance of the potency of groups.
         Fromm, who writes as both a psychoanalyst and social critic, emphasizes society’s effects on the individual. He presents the matriarchal sources of group formation, contrasting the patriarchal “primal horde” with the mother-centered nurturing group. While this group is supportive of basic survival with a sense of acceptance and belonging, individual development may be ignored or restricted. It seems that Yalom has missed a significant curative factor by not including nurturance or a similar quality with his factors. Like many other therapeutic qualities, nurturance is incomplete alone. While the encounter group and counseling/psychotherapy research found Caring and Warmth to be strong promoters of healthful change—qualities that are grounds of sustenance in a Group, Meaning Attribution is another strong factor—not inherently part of the maternal group according to Fromm—promoting differentiation and individuation. In a related approach, the maternal therapeutic significance of being held is emphasized by pediatrician and child analyst Donald Winnicott who studies these qualities in analytic sessions. He sees the analyst, both male and female, as developing the transference role as Mother in the way that he or she establishes a “holding environment” for the analysand. The person of the analyst provides this environment while he or she also represents individuation. A Group with high levels of therapeutic qualities may create a similar effect. ⁹
          Tillich emphasizes Existential Factors , showing that the political organization of society as well as the structure of the group is based on members’ methods of coping with ontological anxieties arising from concerns about nonbeing . These issues are expressed both individually and organizationally, in the methods that group members participate-in-the-world, coming to structure their interactions and rituals, developing direction and meaning. Group functions as a microcosm that models culture for individual members. Anxiety, experienced by members relating to issues of being-nonbeing, is explored in an immediate fashion with other members of the Group. Installation of Hope, Universality, and Group Cohesiveness are factors present in this viewpoint.
         Adler identifies a therapeutic approach that he has named “social interest” as opposed to the more autistic positions of inferiority-superiority. He has clear therapeutic goals: helping the individual develop a reflective relationship in the “Ideal Community” where shortcomings will be re-evaluated and future, socially constructive behavior planned and carried out. Although he describes this interaction as with an individual therapist, the Group is a natural environment that can be developed for this process. Universality, Altruism, Development of Socializing Techniques are present in his therapeutic approach.
         With Mead’s social philosophy we move into actual member-to-member relationships that are present in the group. Interpersonal communication and interaction that characterize the small group actually begin to come into relief. This interaction between individuals ultimately stimulates each to membership as in the developmental game. Universality, Imparting of Information, Development of Socializing Techniques, Imitative Behavior, and Interpersonal Learning can be seen as related to his study. Another important factor promoted by interpersonal interaction, from Mead’s view, is the Installation of Hope, which, although not directly named, develops from a new perspective group members gain on their own behaviors and attitudes through reciprocal relations. This may be seen as the heart of group formation leading to greater choice and self control. Like Adler, members develop goals and direction through communication with others and come to reflect on their own behavior. Participants develop new, active approaches to thier lives. Interpersonal Learning may be considered the basis of these changes, but with the addition of heightened consciousness while developing reflective intelligence through observation of others gestures and complex social interaction in the form of roles and games. These roles and games seem to be summary factors or metafactors, each a gestalt made up from several of Yalom’s “Therapeutic Factors”. The human development framework gives us a model for therapeutic process and progress. Chapter Six, the development of the Crisis Intervention Counselor Workshop, demonstrates how this interpersonal development model provides a foundation and structure for teaching and learning of these therapeutic ingredients.
         Cooley defines a Primary Group. Universality, Imparting of Information, Recapitulation of the Family (the neighborhood should be included here), Socializing Techniques, Imitative Behavior, Interpersonal Learning, and Cohesiveness are component parts of the Primary Group. The group, as an entity, becomes defined with unique properties, not only a trend among others in society. Cooley’s perspective reinforces and dovetails nicely with Mead’s. He grounds understanding of group formation in the child’s experience of the family and then the neighborhood, giving direction for growth and maturity.
         From different perspectives, Frank and Oden review sources of encounter group procedures and techniques, comparing these activities with procedures of older religious traditions. All of Yalom’s “Therapeutic Factors” come into play in the group trends that they have studied including Catharsis, given little attention up to now, except possibly Konner’s description of !Kung San trance ritual—conferring healing powers on select individuals—and my own exposition regarding initiation rites as illustration of Tilllich’s membership rituals derived from those of primitive societies. Catharsis will be given greater attention and described in depth in our upcoming description of Psychodrama.
         In the review of clinical reseach, the quality of interaction that should take place in a Group for positive therapeutic effect is studied. Yalom’s “Factors” were influenced and informed by this research.¹⁰   Four “leadership functions” come into view and are identified by the encounter group research, while three “Therapeutic Ingredients” are developed from therapist and counselor training research by Truax, Carkhuff, and, later, Berenson.
         Lieberman, Yalom, and Miles find that a Group atmosphere high in Caring and Meaning Attribution is directly associated with positive change. Emotional Stimulation and Executive Function are also important factors, but their presence in a group must be maintained at a balanced optimal range for maximum benefit.
         Truax and Carkhuff determine, from their research and reviews of research, that Group Cohesiveness is an important quality to be developed in therapy groups. To be effective, Group Cohesiveness must include three components: Genuineness, Non-Possessive Warmth , and Accurate Empathy. Yalom, while agreeing that these three components are important, points out that the encounter group studies that he and his colleagues did at Stanford show that Meaning Attribution is also vital and necessary for a group to have a healthy orientation. He criticizes the client-centered point of view as being incomplete:

Both emotional stimulation and cognitive structuring are essential. The Rogerian factors of empathy, genuineness, and unconditional positive regard thus seem incomplete; we must add the cognitive function of the leader.The research does not tell us what kind of meaning attribution as essential. (Both group process and interpersonal dynamic clarification seem useful.) What seems important is the process of explanation which, in a number of ways, enabled the participant to integrate his experience, to generalize from it, and to transport it into other life situations.

Theory and Practice of Group Psychotherapy (254:478)

In ending this review of research I would return to an enigma in the encounter group studies, specifically the successful tape Group. I believe that this Group demonstrates several factors that have been overlooked by previously cited authorities. The reasons may be clarified. Several clinicians with whom I have discussed this Group have expressed the belief that there was a covert leader. While this may have been true, it does not explain the Group culture that was developed by all members together. The narrative account of this Group does not indicate a covert leader (136:89-91). This Group was rebellious to authority, members had an ironic sense of humor, and were dissatisfied with the tape as leader. One of the members is quoted:“I’ll be damned if I’m going to let a machine tell me how to be more human“ (136:91). In contrast the other tape group had several failures, although the narrative tells a somewhat different account than the bare statistics: 2 negative changers, 0 casualties, but 3 moderate improvers (136:118). This Group was characterized as obedient: they followed the directions, and programmed warmth. (Actually this Group had some mixed-moderate success according to the narrative, and members were still friendly with one another in the follow-up (136:87-89). Both tape-led Group members remembered the names of the other members better than many other Groups (136:89). The members of the high success Group, in contrast, took responsibility for their own direction and Group tone. Extremely important, especially in light of Norman Cousins’ research on the healing properties of humor (43, 44), is that the members seemed to have fun! (Cousins also found that taking control of your own treatment in medical procedures is a powerful source of healing!). Notice how little these last factors seem to bubble to the surface. We authorities of clinical research rarely mention fun. It’s too close: the members running their own group and enjoying it! Questioning our august authority and knowledge! Counter-transference comes to mind, for those of a psychoanalytic view. Hopefully the next chapters will have a little humor, along with the more weighty issues. As alluded to previously, summary accounts such as Table 3-8 (136:118) and the detailed descriptions of the Groups in Chapter 2 (Liebermann, Yalom, & Miles) seem to tell different tales than the factor analysis. For instance: members of Group #3 [0 casualties, 2 moderate positive, 2 high learners (136:118)] are described as having fun—a good time along with being challenged, focus on immediate experience and feeling, but little cognitive analysis. While directly calling for discussion of experience, Group #3 leader was high in warmth, friendship and protection. The leader seems a good example of how to successfully balance Emotional Expression, Genuineness, Warmth, Empathy, while maintaining Meaning to be mainly regarding immediate behavior. This barely shows in the correlations, if at all. ¹¹ To quote the older English ladies in the Monty Python (an ultimate comedy Group!) TV sketch, deciding whether to watch “Dr. Bronowski on the telly....Bloody scientists! Take all the mystery out of life.”

NOTES Chapter Two

1 Joline, and I have an ongoing discussion about some of Wallace McAfee’s ideas about Groups. She contends, agreeing with him, that a true Group is personal, all members being concerned with one another to the point where destructive and authoritarian attitudes would be viewed as pathological and not promoted by the Group as a whole. A cult would be the results of ‘crowd’-type of experience, rather than the affirming tone of a Group experience. The ‘crowd’ is impersonal and herd-like such as described by Le Bon in the previous chapter. While a Group may have a leader, his or her values should be relatively clear and unambiguous. Membership involves personal development and integration along with Group interaction. Group values are developed and influenced by all members.

2 The four “leadership functions” interplay to synergize their individual effectiveness. This, of course, is the result of the complexity of human communication. For example, Group members who are not usually outgoing may be overwhelmed by the more gregarious members. If the Group environment is high in Warmth, Empathy or understanding of individuals, and Group process, with structure that includes all members, and is appropriately stimulating and challenging, these members will not be lost in the flow of conversation, but will be encouraged by other Group members to contribute their unique participation to Group interaction. Other examples of synergy can be seen in the various expressions of beneficial emotions such as Warmth. Warmth is expressed in different manners as a function of Caring or a function of Emotional Stimulation. Likewise interpretations are expressed differently leading to Meaning Attribution (“What do you think about this? How did this all come about?”) or as an Executive Function [“You seem uncertain (empathy?) about these issues. Please talk about this.”]. Likewise Warmth may be expressed as an expression (“I’m so glad you’re here.”) or with a great deal of Executive quality: (“I’m concerned. I think it may help for you to talk about your issue.”) Warmth may even be included as a function of the environment: rigid classroom seating, pillows on the floor, outside as a picnic or natural environment, even a campfire or fireplace. In the follow-up Carkhuff and Berenson also recognize that these Ingredients promote and synergize one another. They also warn that Genuineness with highly critical or negative regard, while sometimes promoting change, may also be alienating. Too deep a level of Empathy may also be perceived as intrusive. They recommend an introduction at Level 5 and a development of relationships toward Levels 6, 7, 8, 9 (These levels are discussed in the next section of this chapter). [Beyond Counseling and Therapy (31:8-20)].

3 While there are many accounts of therapy group approaches and anecdotal accounts of successes in the literature, statistical studies of group therapy outcomes are limited. Reasons for people coming to a counselor or a Group often vary and do not fall within the categories of immediately measurable successful change or failure. Examples would include a person who attends a vocational counseling group. He or she may make certain decisions regarding job preparation and search but not have measurable personality change or even an immediate reduction of stress. Over time however personal decisions are made that are beneficial if the counseling or Group is helpful. This, of course, can be called improvement, but the process is difficult to follow in a short period of time and the argument could be made that a person seeking employment or job training would continue with or without counseling. Measuring comparable job satisfaction over the course of years or a lifetime, and correlating it to counseling experience, is a daunting task. Techniques for reducing stress while practicing a job interview as well a rehearsal and improving presentation of self may be considered an educational function or counseling, but I would certainly consider part of this process to include psychotherapy. Another example of difficult evaluation would be a couple who sees a marriage counselor before marrying. They may not change significantly but learn techniques of communication that come in handy later on. If they decide to postpone marriage or even not marry, would this necessarily be considered a failure? These issues are matters of research technique or long term follow-up, even including discussion of definitions of ‘success’ or ‘failure’, and warrant whole studies in themselves. There are many instances when aquiring new information and learning sources for future approaches is extremely helpful but not easily measurable with personality type testing. In these cases “Transformation” whether in the Group, or in individual sessions, may be described as an educative function, a counseling function, or, in a more limited sense, a therapeutic function. All of these approaches seek goals of future success as exemplified by improved social functioning and emotional and cognitive enhancement of self. In Chapter 4, I refer to McAfee’s term of this process as “Becoming Fully Human” and Maslow’s description of the “Fully Developed Human” through Self Actualized creativity.

Alvin R. Mahrer: Experiential Psychotherapy: Basic Practices, finds outcone studies very limited in understanding such issues as “...the relationships between patient conditions, therapist operations, and patient consequences.” (143:29-30). He describes about a dozen different areas of concern that outcome studies are often unable to delineate. My descriptions, case examples, and “extrapolations” are meant to fill this void.

In my own practice I have had many clients request help with habit control (usually smoking or over eating), school and study difficulties, especially concentration issues, air-flight, job interview types of anxieties and anxieties regarding medical treatment, for instance. I practice and teach hypnosis, self-hypnosis, guided fantasy and progressive relaxation techniques, meditation and mindfulness, autogenic training, for instance. Part of a session may be tailoring an approach and practicing. I often make tapes (now CDs) of sessions for listening by clients and even insist that they listen on their own. Difficulty doing this may be resistance and becomes a focus of therapy; only a small amount of time is usually spent discussing what may be called sub- or pre-conscious issues which psychotherapy would include, such as sources from life history, life style, and social stresses. McAfee taught that a short but insightful discussion centering on developmental conflicts at the right time has a major effect in therapy. While it may be argued that many individuals achieve these same goals on their own (Waiting list cures?—living longer and improved health is a very powerful motivator to quit smoking on its own.) I draw an analogy to a coach in athletics or a music teacher: there is a great deal you can and must do on your own, but a skilled observer-helper will show you approaches, even by critique, that you don’t necessarily know youself.

4 Carl Rogers has published his research about groups in On Encounter Groups (193). He identifies stages by which Group members become involved with the process. Members describe Group climate through testimonial and antecdote. Groups with high Emotional Stimulation and Caring which is similar to Non-Possessive Warmth, are described. Members of Rogers’ Groups seem to continually wrestle with the issues of Genuineness and Rogers’ other favored trait of Empathy. In other published studies of individual counseling and therapy Rogers has developed objective scales and tests to research the relation between activities of the therapist and outcomes. Truax, Carkhuff, and Berenson are heavily influenced in their approach by Rogers.

5 Cf. the first several sections of the Introduction above for portrayals of examples of Therapeutic Ingredients in action. Ronald Laing’s son Adrian presents a dramatic example of his father’s radical practice of these therapeutic factors or ingredients: During a lecture tour of the United States in 1972, at the Chicago Medical Center, Laing was asked to examine a young girl diagnosed with schizophrenia. She was naked in a room rocking. “Without warning he stripped off naked and entered her room. There he sat with her, rocking in time with her rhythm. After about twenty minutes she started talking to Ronnie—something she had not done since being admitted several months previously. The doctors were stunned. ‘Did it never occur to you to do that?’ Ronnie enquired afterward, with mischeivious innocence.” (R. D. Laing: a Biography (126:157) (Empathy, Warmth and Caring, Genuineness, even Meaning Attribution? or just very intense personal interaction and communication!)

6 Twelve-Step programs refer to approaches derived from Alcoholics Anonymous. Each step is a presentation of issues to identify, to gain a new perspective about, and to work on. The Steps provide a graded map toward control of addictive behavior, self care, and a socially oriented life-style. The First Step challenges the new member with a confession of inability to control behavior and their life in general leading to a reliance on a “Higher Power” for help. This step may be controversial, sometimes developing religious arguments. Staff of the half-way house usually are able to maintain “secular” interpretations, but allow residents’ religious perspectives if they find these helpful as long as they do not try to impose them on others. (This issue has sometimes become a topic in Residents’ Group: ‘getting along with people who hold different views’.) As an example, a “Higher Power” may include reliance on the Group and other members as well as staff. This is a type of Universality as well as Development of Socializing Techniques, Hope, Group (and House) Cohesiveness, and other of Yalom’s Eleven. Being taken care of for awhile is accepted and, at times, encouraged, allowing one’s self to heal: ‘three hots and a cot’ is OK. Many residents have lived marginally on the street or survived very chaotic, dysfunctional, sometimes abusive family lives. The Steps in the case of this particular adolescent half-way house, have been modified for adolescents and includes issues of control of broader compulsive behavior than alcohol and drugs such as criminality, violence, etc. The advisory board, which includes clinicians and physicians, has, in their opinions, adapted the Steps for the needs of the cliental, a procedure recommended by A. A.—although the Steps are used for a more general therapeutic environmental structure or ethos for the house including some influence on specific “House Rules”. As I was discussing the maintenance of a smooth House environment, one of the House Counselors spoke of a resident who expressed strong religious beliefs: “That’s the path they choose to walk.” Similarly, Stephanie Brown and Robert Matano contribute to Yalom’s 5th edition (5th ed.:440-443) with a review of Alcoholics Anonymous and its relationship to group therapy, presenting a comparison of the Steps with Group process in spite of A. A. sometimes, as an organization, being critical of psychotherapy and psychiatry in general. Cf. Introduction of this study, particularly the brief history of Group therapy derived from Pratt’s T. B. class, and the section that focuses on Wallace McAfee’s research in the next chapter. At the time of the original writing, in the Human Potential Movement and therapeutic culture of California, confrontation was relatively popular. “The Synanon Game” was being experimented with {Group 13 was bussed to Oakland Synanon [L, Y, & M (136:74-77)]}, being popular in some encounter groups and residential treatment (including adult) programs particularly dealing with drug abuse (also in university graduate programs); this was before that organization’s demise due to development of violent (including weapons) incidents, becoming an illustration of an unhealthy cult leading to ethical, therapeutic, and legal deterioration—probably partially resulting from lack of transparency and critical input from external sources (Cf. Janus: Groupthink (108) footnote 11, below). This approach occasionally still survives in militaristic conditions of some parole early release programs. I have had to counsel with a number of failures on their return to jail as a Crisis Intervention specialist. I am aware of the manipulative behavior of many hard-drug users as well as prisoners, but there are points where they still need human comforting or at least time to vent.

7 Yalom initially named these qualities “Curative Factors.” In the most recent edition of his book, Yalom has changed their name to “Therapeutic Factors” (223:3). The reader is referred to the 4th edition for discussion. This has interesting implications about how the way views about the dynamics of therapy change over time. Rollo May also comments on this phenomena in Love and Will (147).

8 Shafer and Galinsky review the psychoanalytic therapy group: Models of Group Therapy and Sensitivity Training (206:Chapter 3): “…many would argue that…psychoanalysis must always have the individual man, and his unconscious, a central core of its concern. As a result, practitioners of the present model (group psychoanalysis)…claim they do not treat groups per se…but instead treat an individual patient…this time in the presence of other individual patients…also being treated by him.” (206:49-50). Wolf, Katush, and Nattland [The Primacy of the Individual in Psychoanalysis Groups (251) point out that while group psychoanalysis has the goal of helping the individual member strengthen his or her ego, the group can interfere with this process by developing “themes” in which all members are expected to participate. On the other hand, the group, in this way, presents an environment, in contrast to which members can exercise their individuality. This provides a background and stimulus for the analyst’s interpretations. The group also presents a counter to the leader, encouraging individuation in relation to the analyst. Group members often are better with encouragement for each other toward certain insights as in Groups of hospitalized patients where fellow patients seem to have higher levels of Empathy for one another’s experiences and situations. Certain types of suggestions and even confrontations are better understood between patients.

9 Winnicott and his associates make a point that this experience is part of the transference in adult analysis as well as with children. ”Holding” refers to a communicational, emotional action. This is not physical holding, although physical holding is not uncommon in sensitivity training and encounter groups (Cf. Introduction for example.). There are interesting corollaries to “holding” as an activity or quality promoting growth. In Timaeus, Plato describes the cosmos as a container in which the universe is created. I often describe the Group as a “crucible”, a metaphor for a location where personal and interpersonal developmental processes are supported. While I was influenced by my work during college as a metallurgist and analytic chemist, Jung, in his alchemical studies, identifies the symbolic meaning of the crucible as well as several other types of containers (ovens, baths, even sarcophagi, and, of course the womb) as being locations supporting important transformations. It also seems that the ‘Dasein’, (German: being there), the sense of being in an environment or location, the central issue of the philosophy of Heidegger in Being and Time, is a summary name for our sense of location: being-in-the-world. Many Native American rituals include the reference to a transforming enclosed space. Black Elk: The Sacred Pipe (20) sees the bowl of the sacred pipe as symbol of the bonfire, the circle of participants, and the glow of the coal as enlightened consciousness and common communicational experience. There are also kiva ceremonies of Pueblo and, historically, Anasazi, as well as sweat lodge ceremonies practiced by many Native American groups including religious-sweat lodge ceremonies even among Native American prisoners in California (CDCR). These religious-ceremonial-vision Groups meet in many types of enclosed spaces: kivas, tipis, lodges. Carlos Castaneda (35) describes the fire and darkness creating a sense of enclosure. While he refers to a house, he is vague about the exact location of the ceremony of a group resembling the Native-American church of Northern Mexico and the American Southwest. Joseph Campbell (26) and Susanne K. Langer (124, 125) compare probable psychological-emotional effect of the art and ceremonies held within the paleolithic era caves beneith what is now France, with the interior decor of the cathedrals on the surface of the Earth of Europe—the encouragement of religious consciousness.

10 “Therapeutc Factors” seem to be general statements referring to “leadership functions” taking into account more specific trends which were identified in the Stanford Encounter Group study. Recapitulation of the Primary Family Group is a “Factor” which deserves more discussion than it receives in the body of this study. Yalom’s commentary gives both indication of its importance and description of how it is underestimated as a vital factor by group participants: “Family reenactment, or the corrective recapitulation of the primary family group experience, a curative factor highly valued by many therapists, is not considered helpful by group patients…Nor did the encounter group members value this factor highly. However, it is of interest to note that only the successful encounter group members cite this factor as important (Italics added, T. K. W.). The fact that this factor is not cited often by patients, though, should not surprise us since the factor is one which operates at a different level of awareness from such explicit factors as catharsis or universality. Family reenactment becomes more a part of the general horizon against which the group is experienced. Few therapists will deny that the primary family of each group member is an omnipresent specter which relentlessly haunts the group therapy room. The patient’s experience in his primary family obviously will, to a great degree, determine the nature of his parataxic distortions, the role he assumes in the group, his attitudes toward the group leaders, etc.” (254:97).

11 There are several other “Factors” and procedures that are important to discuss leading to a healthier or more productive group environment. Research is incomplete and only hints at their significance. Truax and Carkhuff identify Depth of Intrapersonal Exploration as a therapeutic factor of which that they could not quite gain statistical proof, although it seems intuitively clear that keeping the topic on track and relevant to clients’ development of self awareness is fairly important. They also study the therapeutic impact of varying the intensity of these “Factors” (223:Ch. 3). As presented in the main body of this chapter, Liebermann, Yalom, and Miles find self exploration and Group process awareness to be statistically important for members’ positive change (254). Hammond, Hepworth, and Smith Improving Therapeutic Effectiveness (94) discuss confrontation. They point out that this factor has a great deal of power but also may interfere with processes such as trust. It is dependent on motives, accuracy, timing, and other judgments of the therapist, leader, or Group peers. For instance: “You’ve been talking about this issue for several weeks (months, years?) now. How about planning out a way to change the situation?” vs. “You’re just b.s.ing us all. Stop your round and round. Get off your ass and do something!” The latter might be effective in a Group with trusted friends—and has actually been heard in such—or it may be devastating criticism in a Group with less group cohesiveness and with relatively new members who have not come to understand the relative frankness that participants develop with one-another in time. Insight and depth may also be attempted—another member states: “When you started the Group you said you were trapped by your parents. Now you have us trapped with your ‘Why don’t you?—yes, but.’ game. You’re just trying to punish us and piss us all off instead of your parents. Well you’ve succeeded. You just turn everyone into your personal prison. Stop it!!” H., H, and S. also study the middle phase of therapy, where much of the work takes place. Most clinician seem to like to describe the heroic events: that brilliant insightful interpretation (like this comment) or process of opening involvement. We all have egos too!

The detailed descriptions in Chapter 2 seem to show different emphasis in some instances than the factor analysis. Reading these summaries is an education in Group Transformation itself. Along with successful Group #3, mentioned in the text, Group #8 was balanced, with a leader (TA and gestalt techniques) who was an “expert bundle of happiness” (138:51). Once again, positive affect. Sometimes therapy is not that mysterious, although needing a good deal of practice (and personal growth?) to accomplish!

In a slightly different vector Irving Janis studies administrative groups, forming public policy, whose members have taken themselves in disastrous directions Groupthink (108). He recommends several principles to correct this cult-like skew: 1) The leader should assign each member to be a critical evaluator and time is set aside to share these critiques. 2) When assigning a topic, the leader maintains an impartial stance in regard to where the study will proceed, this being determined by the members. 3) Subgroups with different leaders should be formed. 4) After policy has been formed the group is divided into two groups to evaluate the policy and reform and discuss differences. 5) Each member should discuss the policy decisions being developed with a trusted outside consultant. 6) Outside consultants who are familiar with the topic should periodically be invited to the Group to share their perspectives. 7) At every meeting meant to evaluate the Group policy, at least one member should be assigned as devil’s advocate. (108:262-267).

Additional Comments on Encounter Group Research

Comparing the statistical correlations with the narrative descriptions raises questions but also gives hints for new directions to study. Grouip #5 and #6 were Psychodrama oriented. One led by a psychiatrist, the other by a leader described as having the least clinical credentials. They both had casualties and/or negative changers, but also successes and high learners. #5 leader was the most active and confrontational. It might be speculated that the high risk approaches were beneficial to some members but dangerous for others. Psychodrama is a technique that is explained in detail in Chapter 4 of this study. It is practiced as a therapeutic technique, and although can be effective as education for Group members facing difficult situations and difficult people, I would only involve a person in highly cathartic interactions if there was a commitment to follow-up; I would use diagnostic discretion. What may be a casualty in a limited time Group may also be a surfacing of issues that are addressed in the future follow-up or longer term therapy. The difference between an encounter group as a class where stated goals may be educational, i. e. class credit (hopefully learn something, too), and a therapy Group, would be that the therapist would have some awareness of a member deteriorating or becoming emotionally overwhelmed as well as the member having identified issues to work on with follow up and follow through planned.

II. APPROACH

CHAPTER THREE IS A PRESENTATION

OF PHILOSOPHY AND THEORY AS DEVELOPED

FOR A GROUP IN PRACTICE—

THE BASIS FOR TRANSFORMATION.

CHAPTER FOUR IS A PRESENTATION OF

AN ACTIVE TECHNIQUE—PSYCHODRAMA—BY WHICH

A HEALTHY TRANSFORMATION IS PRACTICED.

CHAPTER 3

THEORY AND PHILOSOPHY OF TRANSFORMATION

The change of wording to “inner reward” comes from another statement attributed to Jesus:

The Pharisees asked him: “When will the kingdom of God come?” He said, “You can not tell by observation when the kingdom of God comes. There will be no saying, ‘Look, here it is!’ or ‘There it is!’ for in fact the kingdom of God is among you.”

A footnote to this verse continues, expands, or shows variations on the interpretation of this thought:

Or for in fact the kingdom of God is within you! or for in fact the kingdom of God is within your grasp! or suddenly the kingdom of God will be among you!

New English Bible, Luke 17:20, 21.

McAfee makes a point that this change of wording to “inner reward” is critical in order not to confuse people with other meanings that the phrase “kingdom of heaven” (which he uses synonomously with “kingdom of God”) has come to be associated. He always emphasizes that these principles should be practiced in order to improve our lives in the present; we should work toward a meaningful and joyous life for ourselves and others.

The Diamond Rule is a principle that McAfee presents that is helpful in dealing with anger. There are times that we receive treatment from others that is difficult. Another person may have been provocative or unfair. Sometimes a situation is difficult with no apparent cause or this may be outside our control or from a source that seems too remote or too powerful for us to deal with. If we respond with anger, hurt, anxiety, or similar emotions, we only compound our dilemma and internalize the negative situation. This experience is only added to what already has a good deal of injustice. Therefore The Diamond Rule: “If we respond to life’s blows with joy, we may grow.” Notice, and McAfee emphasizes this point, joy is not because we have been mistreated—that would be masochism— joy is because we have an opportunity to grow. A clearer conscious awareness of the situation is also part of this process leading to growth. We can grow by developing and practicing healthy responses to potentially harmful situations. An added goal that McAfee also emphasizes is that we do not have to punish ourselves for inner emotional turmoil or even our perceived shortcomings, behaviors we often learned growing-up. While it is important to acknowledge guilt and emotional pain, as discussed late in this chapter, if we transform our reactions with a sense of joy and vitality, we are helped to develop our fuller sense of humanity. The dynamics that will be developed, center around the resolution and transformation of anger. This is McAfee’s central topic in his approach to guilt and forgiveness. Psychodrama, Catharsis and its resolution, the topic of the next chapter, is a model for a transformative approach to anger and other related disturbing emotional reactions such as anxiety, nervous confusion, psychosomatic complaints, and other highly disrupting difficulties. ³

The ideals of The Community of Caring and The Diamond Rule are not easily achieved, probably never completely, but they show a long-range direction for transformation. They are central features of the ideals toward which we work. These are the principles that Dr. McAfee sees as the foundations of his philosophy of transformation.

This chapter and the next present outlook and methods by which these ideals are practiced in the McAfees’ Group. In Section A the basic theory underlying this transformation is presented. This theory is grounded in an ideal related to and encompassing The Community of Caring and The Diamond Rule. In sum, the theory tells us that we experience Guilt to the extent that we misuse or avoid our potential Freedom. By becoming conscious of Guilt and working toward Forgiveness, we may grow toward our ideals. The Group, in its realization of The Community of Caring, offers both a source of reflection for properly establishing Guilt and also functions as a mediator of Forgiveness. By establishing an appropriate Group environment, the theories and research presented earlier are focused into a healthful Group process.

Section A of this chapter represents my description and summary of the philosophy that underpins Dr. McAfee’s approach to Group and transformation. Then, because Guilt and resolution—Forgiveness—is a focal dynamic to this process, in Section B I will discuss these issues, comparing them with the points of view of three prominent clinicians. In Section C Wallace McAfee’s views are presented verbatim. While Section A, being theoretical, is more of a structural presentation of the philosophy as it is communicated in practice, Section C is a discussion with Dr. McAfee about his reasons for developing Groups in this particular manner. It should be noted that the Group is constantly evolving and this statement should not be taken as a final one about Groups; this interview reflects Dr. McAfee’s thoughts at the time of this writing and interview (1977). We are then led to Chapter Four which presents Psychodrama, one highly effective technique by which this theory and philosophy is practiced in Group, for use in greater life beyond the Group.

This description of Group is necessarily only partially complete. Like the magnifying glass examination of DaVinci’s fresco mentioned earlier in this paper, I am only able to portray a small sample of actual Group activities. Likewise, in the next chapter I concentrate on the technique of Psychodrama and not mention many other therapeutic methods that the McAfees employ toward Group goals. These include modified and broadened hypnosis, de-conditioning and re-conditioning of healthier responses to difficult and stressful situations, controlled ‘rage’ experiences, exercises which build self esteem through muscular and emotional effort, and participation in a broad social milieu outside of the Group, activities that go far beyond the meeting. Group activities have included visiting members and non-active members and accompanying people for support to meetings that they find difficult. Some examples of these ‘outside’ situations where Group members have supported one another are classes, jobs, court appearances, hospital and medical situations, participating and leading church discussion groups and Sunday Schools, and meetings with family members. Group members have taken one another into each others’ homes, temporarily, if a family situation is too difficult. This has included caring for very confused or emotionally overwhelmed members during outpatient psychotherapeutic treatment. As one Group member joked: “McAfee boots us out to do something.”

A. Sources of Freedom. ⁴

The Group philosophy that underlies the transformation that we are studying centers on two dynamic tensions. First, each individual Group member personifies a tension of growth. Second, we participate in relationship to other members of the Group. These tensions are both our individual challenges and our Group challenge. Following Wallace McAfee’s description of the behavioral dynamics of choice and freedom, we see ourselves as moving from a position described as “Compulsion” toward an ideal of life described as “Freedom”. The second tension, the individual’s relations to the Group, is the topic of the greater part of this study. It may be viewed as the macrocosm. The first tension, the challenge to each individual member to change and improve, is the microcosm and is the topic of this chapter. In this section we will concentrate on the Compulsion-Freedom parameter that each member develops for himself or herself to promote personal development.

The structural description that follows is my distillation of Wallace McAfee’s Group ideals. He would probably differ somewhat (hopefully only ‘somewhat’!), from my description of his philosophy if asked by a third party. Group members differ with one another’s views, would differ with my understanding of Wallace’s ideas, even differ with him about his own ideas. This often happens in Group sessions. We have many discussions comparing and contrasting ideas both individually and in Group. In this study, I attempt to understand and summarize his views which are well established from a great deal of experience while still constantly evolving. He is always interested to understand our views. Sometimes his questions about our views are unsettling. Trying to make conscious what he likes to call “half baked ideas” (with both positive and negative connotations) is not always easy. This is part of the dynamic process that makes Group interesting and challenging. The next step is to apply these ideals to our everyday lives and our interactions with our significant others. Therapy often moves a person into new areas of approach to life; at times it is uncomfortable, always intellectually and emotionally stimulating, and sometimes fun.

I am using the word Compulsion in the broadest sense, not merely as a psychiatric diagnosis describing socially destructive or dysfunctionally repetitious behavior. Human beings have the ability to allow life passively to take place. (Although even in this statement, words like “ability” and especially “allow” signify a realization of rudimentary choice.) In the course of life, habits develop. It is likely that these habits, like instincts in other animals, have been maintained in our behavioral repertoire due to their survival value, but with no thought and little effort we continue life in a state of inertia, only to change course when another force impinges upon us and then only to the degree and direction of that force. ⁵ The description that William James uses to illustrate habit in his Principles of Psychology is of an old coat hung on the rack so long that when finally worn shows the indelible marks of the hanger (104:104). True, as James also points out, life would make no sense to us if we were not able to retain our past experiences. We could be overwhelmed with minutia. We would be like the four-year old taking half-an-hour each morning to tie our shoes. Once the task is learned, we go on to other challenges and tying our shoes is habitualized to less than a moment. The thought of tying shoes does not clutter our conscious mind. Probably most of us did not even think about what we were doing when we tied our shoes today (104:113). Were our existence to be one of summation of habits, the learning theorists would have our psychology figured out and sealed up (Except that we would have to find how learning theory itself existed before it was described and Pavlov, Thorndike, Watson, Skinner, et. al., would have to return the awards and adulations as developers of the field, this having happened by chance and reinforcement.).

As Mead shows, while we interact with other people, we become known to them and they become known to us through quality personal communication, We reflect on our behavior and attitudes, sometimes even who we are. Communication from others helps us to develop new insights about ourselves. We come to understand that some of the things we do or have done ‘habitually’ actually involves choice. We see how we may have made better choices in the past and where we can make improved choices in the future. This is the catalyst for the development of Freedom.

The important point for our philosophy is that Compulsion and Freedom co-exist as a part of life; one sometimes eclipsing the other in our thinking about our acting, but, also, each affirming the other. It is upon the foundation of these habits that our more complex activities develop. When these habitual behaviors come to interfere with growth, however, Compulsion has blocked development. John Dewey Democracy and Education describes both advantages but also traps of habit: “...(habit) means the formation of intellectual and emotional disposition as well as an increase in ease, economy, and efficiency of action.” He then describes several expressions of habits including: intellectual disposition, acquaintance with materials and equipment, ways of understanding the situation, modes of thought, observation and reflection, judging and reasoning. He cautions, however about fixed habits: “But the phrase is also used to mean ruts, routine ways, with loss of freshness openmindedness, and originality. Fixity of habit may mean that something has a fixed hold on us instead of our having a free hold on things...two points in common about habits: their identification with mechanical and external modes of action to the neglect of mental and moral attitudes, and the tendency to give them a bad meaning...‘bad habit’.” Dr. Dewey‘s description approaches diagnostic detail: “Habits reduce themselves to routine ways of acting or degenerate into ways of action to which we are enslaved just in the degree in which intelligence is disconnected from them... ‘bad’ habits are habits so severed from reason that they are opposed to the conclusion of conscious deliberation and decision... that possess us instead of us possessing them...that put an end to plasticity... short-sighted method which falls back on the mechanical routine and repetition to secure external efficiency,... motor skill without accompanying thought, (marking) a deliberate closing in of surroundings on growth” (50:49).

There are finer distinctions to be made in the polarity between Compulsion and Freedom. A parallelism of approach may be described. To the degree that we act out of Compulsion, we are excusable. We do not choose our behavior so we cannot be held responsible for the consequences—although the results of these actions may still be problematic or damaging. To the degree that we act out of Freedom, we are responsible for the consequences. If the results of our free act are disastrous, as we come to be conscious of this, we will experience Guilt.

As we stand in the present and reflect on the past, it is not hard to find situations in our lives that were not exactly what we would wish for could we relive them. It may be that we failed or that another person failed us. If we find, in our meditation, that the situation could not have happened otherwise, we assign a high degree of Compulsion and excuse ourselves or the other person involved. The word ‘failed’ also does not belong to this description as it signifies possible choice. Continued resentment or agony is also not a part of excuse and may indicate that we are really assigning a higher degree of blame than we realize. When we blame either ourselves or others, we are assigning responsibility and assuming that the participants in our situation acted largely with Freedom, i. e. they could have chosen otherwise. Guilt, then, is the experience of accepting blame and responsibility for our acts. We realize that, out of free choice, we chose or acted wrongly; we did not fulfill our human potential.

Often, however, awareness comes in the opposite order. A person may feel Guilt about an action but verbally, consciously, deny responsibility. Guilt, however, indicates a sense, perhaps an intuition, of responsibility, although we may not be quite sure what that responsibility is at this time. Guilt is often described by McAfee as the “hope word”: an indication of the presence of Freedom.

Before proceeding, we may summarize:

Freedom: Choice:; Self Control → Responsibility Guilt.

Compulsion : Habit;Conditioned Behavior → Excuse.

The categories Freedom and Compulsion are never pure in human life. Every act has a certain percentage of Freedom and a certain percentage of Compulsion. Our goal, then, after recognizing the presence of each of these categories in past actions, is to look toward the future and work toward increasing Freedom. To accomplish this we must return to our “hope word”. Our Guilt is an indicator of our Freedom.

Guilt is not the end, however. As long as we are Guilty, we recognize our Freedom but also feel that we are not acting in accord with it. A mismanaged past yields a mismanaged present and points to a mismanaged future. We see this and feel the Guilt of it all. So What?!! This sounds pretty much like the fatalistic and sometimes fatal inertia of Compulsion only with a load of Guilt besides! Sometimes it hits us all at once and can be overwhelming!

The other possibility that we mentioned briefly is Forgiveness. We are not referring to a simple formula, however, i. e., listing of sins, receiving a recipe of acts of penance or a brush off with a facile ‘OK’ like: ‘I’m sure you meant well. Don’t sweat it.’ Then after a trite assurance of Forgiveness continuing life as usual. It is also not a rush of crowd contagion with babbling, jumping, rolling, sweating possesion, leaving ‘reborn’. Forgiveness, just as life, is quite a bit more complex and requires some thoughtful, sustained work. This central approach, then, to transformation, is the realization of Guilt and the acceptance of Forgiveness. It is on this topic that we will now concentrate.

B. Guilt - Resolution - Forgiveness

One of the central premises of McAfee’s approach is that as we become aware of Guilt, we accept Forgiveness. In this process we liberate (or develop) our Freedom. There are two additional points to be clarified:

1) Guilt without Forgiveness is incapacitating.

2) Wallace McAfee designates the word “Freedom” as refering to internal Freedom. This is the ability to choose with a clear perception of options and without emotional conflict. Often this Freedom is confused with Liberty which he defines as an external corollary to Freedom. General usage in greater society may interchange these concepts without clear distinction. Liberty is a description of a situation when members of our society, at large, are expected to unconditionally accept a person’s behavior—sometimes even either beneficial or detrimental—based on choices that he or she makes. In the previous chapter I referred to A. S. Neill’s name “License” in reference to some of his students’ difficulties taking responsibility for their behavior—often self defeating or harmful to others—expecting general acceptance. This is a more precise framing of the situation. The use of the word Liberty by political philosophers, including our Founding Fathers, for instance (Locke’s Two Treatises on Government and Letters Concerning Toleration were particularly popular with them.), has deeper, thoughtful, moral implications to it. Patrick Henry’s “Give me Liberty or give me Death!” certainly has an expectation of ethical behavior. (Although the British probably didn’t think so!) The Statue of Liberty is welcoming people who have been oppressed by malevolent autocratic powers. This may include personal, social development with a good deal of hard work.

Guilt and Forgiveness are best known for their use as ethical or religious and theological concepts. McAfee and other writers have noted how many psychologists and therapists (as well as ministers and religious leaders) deal with these concepts with suspicion or at least reservation. Often they ignore or devalue the impact of Guilt on a person. F. S. Perls, one of the founders of Gestalt Therapy, presents a perspective that begins to bring out some of the complexity involved in the process of becoming aware of Guilt:

We see guilt as projected resentment. Whenever you feel guilty, find out what you resent, and guilt will vanish and you will try to make the other person feel guilty. Anything unexpressed which wants to be expressed can make you feel uncomfortable. And one of the most common unexpressed experiences is the resentment. This is the unfinished business par excellence. If you are resentful, you’re stuck; you neither can move forward and have it out, express your anger, change the world so you will get satisfaction, nor can you let go and forget what disturbs you. Resentment is the psychological equivalent of the hanging-on bite—the tight jaw. The hanging-on bite can neither let go, nor bite through and chew up —whichever is required. In resentment you can neither forget, and let this incident or person recede in the background, nor can you actively tackle it. The expression of resentment is one of the most important ways to help you make your life a little bit more easy. I want you to do the following collective experiment:

I want each one of you to do this. First you evoke a person like father or husband, call the person by name—whoever this is—and just say briefly, “Clara, I resent-” Try to get the person to hear you, as if there was really communication and you felt this. So try to speak to growth. Behind every resentment there are demands. So now I want all of you to talk directly to the same person as before, and express the demands behind the resentment. The demand is the only real form of communication. Get your demands into the open. Do this also as self expression: formulate your demands in the form of an imperative, a command. I guess you know enough of English grammar to know what an imperative is. The imperative is like, “Shut up!” “Go to hell!” “Do this!”...

Now go back to the resentments you express toward the person. Remember exactly what you resented. Scratch out the word resent and say appreciate. Appreciate what you resented before. Then go and tell the person what else you appreciate in them. Again try to get the feeling that you actually communicate with them...

Gestalt Therapy Verbatim (171:48-49)

Guilt has a simple explanation for Perls: projected resentment. Resentment itself is more complicated. Resentment is a situation that we feel is unfinished. Consequently, we continue the situation, not always consciously or within our control. (Perls, who emphasizes “Here and Now” communication would undoubtedly not agree with the evaluation of an idea that we are not conscious of or being beyond our immediate control.) While I believe that we may agree that resentment and Guilt are often found together, it seems that Perls has reversed the generalization. He is guilty of subsuming Guilt under resentment, but resentment is one of a special case of behaviors that lead to Guilt. Still, this is a more profound explanation of Guilt than many others employ as well as an action oriented technique for developing this experience therapeutically. While McAfee understands guilt as “the hope word”, Perls’s gestalt shift begins with guilt, shifts this to resentment which is the result of an unanswered demand, but ends having group participants appreciate the action or person who is the source of the original emotion or feeling. This is an optimistically flavored (Note Perls’s oral emphasis.) experience, similar in tone to McAfee’s expression of guilt as “the hope word”.

McAfee occasionally cites for criticism a position toward guilt that he has heard from psychologists and theologians alike. This is basically: “Live in the present. The past has happened and there is nothing that can be done about it. Continuing to feel guilty for something that cannot be changed is just hurting yourself to no avail.” This statement describes an understanding of Forgiveness exemplified in the so-called folk wisdom: “Forgive and forget.” The problem with this position toward Guilt is that it refers us back to our state of Compulsion for which we are excusable. It does not leave us with the dynamic processes on which Freedom, with its ingredients of personal responsibility and personhood, is built. It does not challenge us toward an improved future. There are, however, therapists who see Guilt as a central issue in psychotherapy. Andras Angyal, who has developed a holistic approach to the treatment of neurosis, writes about the importance of recognizing guilt as a focus in therapy:

Many therapists regard guilt as an entirely negative feature, i. e., as neurotic symptoms to be removed or relieved. This, I believe to be a mistake responsible for many of our failures; assuaging guilt does not resolve it.

            One should certainly try to remove those guilt feelings that originate in an assumption of responsibility for events over which the person has no control. Consider, for instance, the patient whose mother died in childbirth and who harbors guilt feelings about it: “I came into the world through the death of another.” Such feelings should be analyzed as fantasy productions since no true guilt is involved. However, such simple and straightforward situations are rarely, if ever, found in analytic work.
            The focal problem is real guilt...i.e., the person’s emotional response to having acted against not just some externally imposed standards but against his own genuine loyalties or against people to whom he related not merely with fear but with love.
            To feel guilt about such violations of homonomous bonds is part and parcel of healthy human functioning. If a patient has betrayed his own values, or has caused or intended harm to a loved person, he is not helped in the long run by the therapist saying or implying that it is foolish to feel guilty about it—because that is not true. Although the neurotic puts his guilt to very destructive uses, in essence they are outgrowths of basic strivings of belongingness and autonomy; as such they must be utilized for reconstruction, not summarily discarded. Real guilt has to be faced in a much more meaningful and vital way than by denial or making light of it. Only a confrontation with it can help the neurotic transform his partly irrational guilt feelings into a healthy conscience. Guilt feelings represent the key to effective self-control...
            When manifest guilt feelings are minimal or absent, the therapist’s first task is to bring them to the patient’s awareness by utilizing the indirect implications that both reveal and disguise guilt. Some of the most common disguises are certain brands of fears, symptoms, or behavior patterns that have the function of “undoing” the acts leading to guilt, protestation of perfect goodness and innocence, distortions of reality systematically aimed at minimizing one’s own guilt, or lack of emotional response to instances of obvious factual guilt. On the other hand, conscious guilt feelings may be present and even prominent, but on the surface they rarely refer to actions or attacks that caused the real guilt. This guilt, of which the patient is aware only dimly or not at all, is usually camouflaged by manifest guilt feelings, often exaggerated or irrational.

Neurosis and Treatment: a Holistic Approach (7:233-235)

Angyal sees that a decisive step comes with the realization of responsibilty:

...to take responsibility means to acknowledge, simply and frankly, the part played and is still playing, in all one’s self destructive mode of living. By admitting this to another, the patient discards his false front and moves beyond the confines of anxious secrecy. This is a momentous step forward: he could not have taken is without some confidence that he can live differently in the future.

There is only one way of dealing with guilt—to regret it. This means sorrow for the harm that was done and the constructive action left undone: for the chances that were never taken, for the adventures missed and perhaps no longer possible, for having shortchanged those who loved or needed one and tried in vain to come close and be helpful. Beyond the regrets it means turning one’s back on the neurotic pattern, with the strong desire to discard it and live in a different way. When the patient begins to react to the destructiveness of his conduct in life with strong feelings of regret, the neurotic structure starts to give.

Neurosis and Treatment; a Holistic Approach (7:239)

Guilt, then, may have a pervasive influence on a person’s life without really being experienced, at first, as Guilt. By bringing Guilt to consciousness and then working with it therapeutically, a person liberates Freedom.

In my own work with Crisis Intervention patients (Chp.6), Guilt is often spoken of directly or in the course of the interview. The too common response like “Oh, you shouldn’t feel that way.” or “Just get over that.” is not helpful. Encouraging a discussion of the sources and feelings of responsibility that the patient experiences is the first steps toward resolution or Forgiveness, as it is referred to previously.

Robert Jay Lifton, in his study Home From the War, elaborates on these points and describes the course of renewal developed by returning Vietnam veterans. He begins with the processes many of these veterans share to help themselves and others to return and re-integrate to American society. In his research observing veterans’ ‘rap groups’ Lifton describes how these returning veterans deal with their war experiences, their perceptions about how others feel about them, and how they feel about themselves as they return home to American society.

He observes the initial process rap group members come to developing this awareness and action as Animating Guilt:

The American survivor of Vietnam carries within himself the special taint of war. His taint has to do with guilt evoked by death. His most disturbing images are of particular encounters with the dead and dying; his harshest self-judgments emerge from these encounters and concern not only what he did or did not do but his sense of the overall project that he was a part of.

In the rap groups the men frequently talked of their resentment of others viewing them as “monsters,” “beasts,” and “murderers.” But before long they made it clear that these were their own self-judgments as well. A typical sequence was that of one man who describes being unable to take a steady job...largely because of what he perceived to be negative attitudes of prospective employers:

They would think, “There’s a murderer, a monster. I sometimes think that myself.”

One man in our group told of being spat upon by an anonymous greeter at the airport when he returned, an experience referred to so often as to become a kind of mythic representation of the feeling shared by the American people and the veterans themselves: an image of Vietnam as a war of grunts immersed in filth (rather than one of noble warriors on the path to glory) who return in filth to American society.

In all this the veterans struggle toward a new relationship to their guilt. They sought from the very guilt that seemed to hold them in static ‘deadness’ an energy for ‘coming to life.’ Indeed their entire relationship to their antiwar organization was bound up with this quest. There were two important images involved. The first had to do with their transgressions, their having caused (in Buber’s phrase) “a wound in the order of being,” their having ‘killled’ someone or something. The second image was an image of a world beyond transgression itself. That is, to transcend the conditions of the transgression (the atrocity producing situation) one had to open oneself to the larger “order of being” one had injured.

Home From the War (137:99-104)

Unfortunately this study can offer only a hint of the deep pathos that these veterans experienced both in Vietnam and on their return to our society. The experiences of the veterans show us, however, the complexity of the process and dynamics of accepting Guilt and Forgiveness, an experience so often taken to be a single, simple act. They had to come to grips with some of the most monumental feelings imaginable. Because the members of the Group understood one anothers’ experience, they were able support the emergence of these very difficult feelings. The process began with the sharing of experiences of anger, rage, and potential violence. This was not focused only toward an enemy but towards themselves, fellow soldiers, their commanders, and their own society. But with this rage there was also an overwhelming sense of unreality about the entire situation. Vietnam and the army is described as a “Counterfit Universe” (137:161). This is a not uncommon means of surviving an unliveable situation in which personal sensitivities are buried and protected by devaluing the environment. ⁶

Not only was guilt related to physical violence but also social violence. The nature of war makes it necessary to identify the enemy. This leads to classifying humans as enemy or friend or in the case of soldiers in Vietnam as “Gooks” and “Men”. ⁷

At this point we have only begun the process of recognition of Guilt, the first step toward Forgiveness. Lifton outlines three transformations by which the men come to grips with their experiences. First the image of the warrior had to be redefined. Lifton was working primarily with veteran antiwar Groups. The mythic hero that these men chose to represent this transformation was from John Wayne, the hero image that the typical American G. I. was supposed to emulate, the TV and movie hero most people of this generation grew up with, transformed to Country Joe and the Fish. The latter was a Berkeley acid-rock and protest band who were known for their song I Feel Like I’m Fixin’ to Die Rag, the tone of which is given in the song refrain:

(To a bright ragtime melody)...

And it’s 1, 2, 3, what are we fighting for?

Don’t ask me, I don’t give a Damn,

Next stop is Vietnam.

And it’s 5, 6, 7, open up the Pearly Gates.

Well there ain’t no time to wonder why.

Whoopee! We’re all gonna to die!

This tone is reinforced by verses exhorting: “Come on mothers throughout the land, Pack your boys off to Vietnam, Come on pops don’t hesitate, Send them off before it’s too late, Be the first one on your block to have your boy come home in a box!” (A rousing performance of this ’60s classic—for many more people than Veterans—can be viewed in the movie Woodstock.)

As identified in other parts of this study, we have here the therapeutic combination of sometimes brutal reality, deep irony, personal responsibility, and dark humor.

The second transformation was learning to feel:

Overcoming psychic numbing meant transforming a ‘dead self’ into one infused with life. Until they can begin to do that they find themselves in that survivor state of death in life that is not quite the one or the other.

Home From the War (137:279)

One veteran reports about the initial stages of the return of his feelings:

The first session when I went down there, I almost couldn’t drive back to New Jersey. Every song that came on the radio, you know, now I feel it...If I hear...about something beautiful (I) get so sensitized that I can’t even function.

He was describing the lifting of psychic numbing the uneven process around loss, death, and the possibility of a joyous life. This formulative struggle of the survivor in this case a struggle for feeling related to form has many parallels with what Freud called the “work of mourning.” But it is more generalized process of resymbolization, involving the entire psyche and the inner images and forms built up (and broken down) over a lifetime.

Home From the War (137:278)

But this process first required that the men release their rage, often held in tight control in order for them to function in society. Because the Group members effectively understood this rage in one another, the Group was able to help. The members also understood the potential each man had for tender feelings and this became important as feelings were allowed, even encouraged, to return.

The third transformation is the development of a new inward experience and outward expression of life. The veterans found new meaning in relation between self, society, and the world. It is here that Lifton finds the experience of veterans speaks directly to all of us. We all need to understand what the veteran has discovered.

To be sure, Americans (and others throughout the world) are surviving much more than Vietnam. Our unprecedented historical velocity and our holocausts (actual and potential) merge into a confusing ethos, with Vietnam at the malignant cutting edge. Lukacs’ claim that America is reading the signs of “its earthquake in a similar spirit” is perhaps rephrased by the question: Can a significant number of Americans muster enough survivor wisdom to create the kind of forms that would be ethically adequate to the filth of the holocaust—and psychohistorically adequate to the unprecedented needs of our social moment? That is, can we respond to the constructive model transformation suggested by certain veterans, whatever its imperfections and fragility?

Home From the War (137:305-306)

Once the issues of Guilt are made conscious, work toward Forgiveness has only begun. Although Lifton does not use this word, the therapeutic process that he outlines is an excellent description of psychological healing toward Forgiveness. Lifton summarizes this third transformation into three stages:

1. Confrontation.

2. Reordering.

3. Renewal.

Confrontation consists of a sudden or sustained questioning of personal integration and integrity brought about by some form of death encounter. Whether or not actual physical dying is involved, the encounter includes an indelible image of personal threat. But accompanying that threat is an opening toward greater awareness of the non-viability (falseness, inadequacy, deadness) of previously unquestioned inner forms (values, assumptions, symbols), and the possibility (however dimly perceived) of alternatives. The image representing this is indelible (though often ineffable) because it suggests the idea of death or nothingness in a newly powerful fashion. It does this by bringing together, at least for the moment, adult knowledge (or perhaps “middle knowledge”) of actual death with reactivated early images of disintegration (or annihilation), separation, and stasis. In this way the idea is newly connected with primal images on which it is built—hence the sense both of newness and the “shock of recognition.”

Home From the War (137:387-388)

At this stage the experience may seem both disorienting but familiar. There seems to be a demand for taking responsibility and, therefore recognizing personal guilt.

To confront this kind of threat to integrity is to experience guilt, and to confront the guilt in turn is to initiate the second stage, that of reordering. Reordering involves alteration and recreation of every aspect of self-process, but it revolves around the struggle to achieve an animating relationship to guilt.

Home From the War (137:390)

Throughout the reordering process there is a struggle to confront guilt and reclaim (or establish for the first time) a sense of integrity. Reordering can include the softening we spoke of earlier, the breaking of some of the character armor, the long-standing defenses, and maneuver around numbed guilt, in order to release feelings appropriate to conflicts around integrity. For the person undergoing this process is struggling to bear witness to the upheaval (death encounter) he has experienced, and to do so with autonomy and authenticity.

Home From the War (137:392)

Finally, the process of renewal includes regaining the ability to play. The return of this experience magnifies the healing process, as was pointed out in the close of the previous chapter, and has special interest for us in the next chapter.

We can speak of renewal (italics added) of the self”s attainment of form (structure) and style (process) in relationship to its integrity. Form itself is fluid, which is why structure and process cannot be separated; through both, the individual develops an inner sense, persisting through continuous change, that his new integrity is a part of him.

This does not mean that guilt disappears. On the contrary, the process of converting static to animating guilt is continuous and continuously important. But as an animating relationship to guilt comes to predominate, it is increasingly accompanied by play. Piaget has said that a child, in order to understand anything, must construct it himself or “re-invent it” through play. And Erikson, in a recent study of the full gamut of play, concludes that play is so widespread and fundamental a human phenomenon as to be grasp only by the word “aliveness.” ⁸

From early in life play is at the center of the formative process, the means by which the self, in a state of freedom, re-creates its images and forms. That freedom to create and explore—to subvert, mock, or reinforce old forms and initiate new ones—is a psychic key to play, though play is never without a structure and set of rules of its own. And play always envisions a state of unity encompassing inner and outer worlds.

Home From the War (137:401-402)

Play’s unique ability to relate our present to our entire developmental process leads to renewal.

Indeed only play, in its broadest meaning, can approach the ecstacy or experiiential transcendence necessary to affirm a mode of immortality or bring about a shift in modes.

Play is also the great unifier of the life cycle—its formative-symbolizing function enabling the child to build adult forms, and the adult to retain the child within.

Home From the War (137:402)

As part of Forgiveness this is a continuous process and can be effectively approached in this way:

In emphasizing play, I am suggesting that renewal is at no point simply accomplished. Rather, it is a process that, once established, can combine enduring forms with perpetual re-creation based upon an evermore accessible ideal of integrity. The process can extend into diverse areas of work, human relationships, contests or competition, and teaching and learning—all of these increasingly infused with combinations of animating guilt, playfulness, and responsibility.

Home From the War (137:405-406)..

We have looked at the views of three clinicians regarding Guilt as a focus in therapy. Perls, Angyal, and Lifton all find that therapeutic awareness of experiences of Guilt leads to deeper processes of healing. Although their views differ somewhat, I would like to refer to these perspectives as an introduction to Wallace McAfee’s approach to therapy and the organizing function of bringing Guilt to awareness as a process of transformation in the Group. I would emphasize the ways that Guilt and Forgiveness (capitalization emphasizing the central importance of these processes) are central to the therapeutic process in his Groups. Following on the consciousness of Guilt, Forgiveness is the process of individual and Group transformation. Although the three previously discussed therapists have not specifically used the word Forgiveness, their healing processes may be taken as examples.

It is relatively easy to understand the necessity of dealing with Guilt in the case material and theories of Perls, Angyal, and Lifton. The special methods for resolving resentment, neurosis, and the experiences of war, while offering valuable insight into the nature of the process of Forgiveness are, however, easy to isolate from our day-to-day lives. This process may be a form of what psychoanalysis calls repression. We can too easily ignore Guilt in our more common experience. By extending this process to our everyday lives, we can achieve a greatly enhanced sense of living. It is at this point that I turn to Wallace McAfee’s views.

The following is a transcript of a taped discussion that I had with Dr. McAfee in late 1976. I asked him to give a general description of his therapeutic philosophy that I could include as part of my dissertation. This was to be representative of part of the therapy, training, and supervision that I had with him.
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C. Guilt and Forgiveness in Everyday Life.

We begin Wallace McAfee’s exposition with a central paradox: the problem of Guilt, Forgiveness, and the development of Freedom.

                 “Why should I be Forgiven? I should be Forgiven because I have the brain and with the brain I can choose. You can then assume that I will choose wrong against some of my social values. Well, here’s the paradox: You put me in a situation where I’ll choose wrong, then I’ve gone against my standard.
           “If you do wrong and accept Forgiveness you have more Freedom. You’re not going to be beaten for it, but you see things in a different perspective and accept Forgiveness.
           “We feel Guilty when we have the Freedom to act according to high principles, and we choose the less social action. We, in some way, harm another person or don’t do right by them.
           “When we go out into this world, with its complexity of living, we hardly expect that we will always choose correctly, but then we say we’re Guilty when we don’t. There is the principle: ‘Be thee therefore perfect as your heavenly Father is perfect.’ But then we can’t really expect that we do the appropriate thing every time.”

McAfee stresses the problem of the Pharisee.

“The danger is, as we work toward becoming better counselors, that has the seeds of becoming a Pharisee. In becoming better at what we do, we are in danger of becoming a Pharisee.”

McAfee likes the metaphor of “traveling”. The early Christians spoke of “Traveling in the Way”.

             “Robert Louis Stevenson spoke of this in Travels Through France With a Donkey. He said that it is better to travel than to arrive. I think that he meant that he had a series of arrivals,
           “Our metaphor is one of making movement. We should say that ‘I am being saved.’ or ‘I ambeing Forgiven.’ rather than ‘I am saved.’ or ‘I am Forgiven.’
           “Forgiveness is offered but it must be accepted.”

I asked about specific action. I purposely used a trivial example: littering.

            “The paper on the sidewalk showed a little bit of an anti-social attitude. Then the Forgiveness should be accepted for the anti-social attitude not just the single piece of paper. At first you may not have realized that that act is a symptom of a deeper attitude.
           “Then Forgiveness is admitting the present problem and, as you make restitution, you are being Forgiven for that action—and probably other related actions that come from the anti-social attitude such as driving carelessly.
           “As you come face to face where you are Guilty and begin to accept Forgiveness, your Freedom grows more and more.
           “Freedom is being able to face the issue of choices and being able to take the choice that is appropriate with a social value system. Anyone can choose between two choices, but Freedom is the ability to choose in relation to a social value system.
           “Then Freedom also includes the ability to see the deeper issues involved.
           “Freedom, then, is a choice in line with our ultimate social values. We hypothesize what these ultimate values are and choose according to them.
           “Part of this hypothesis is that we must take all the circumstances into account. This is George Herbert Mead’s phrase: ‘Take all the circumstances into account before making a decision.’
           “Then Freedom is based on ultimate social values. And here’s the paradox: If we are going to take all the circumstances into account before I choose and choose according to ultimate social values, then can we call that Freedom? It seems that I couldn’t have chosen any other way than I did, given the circumstances. I am free, but yet I am bound by the value system.”

McAfee may have sensed that I was teasing or expressing a sceptical view with my littering comment and responded in kind by personalizing his evaluation as “a bit of an anti-social attitude”. Touche!
He names the “ultimate social values” that he refers to Principles of Bio-Social Evolution.

             “I have a part in advancing Bio-Social Evolution. Now, how do I do that? Now this is something that I am hipped on! First, it is important that I have the brain. (Wallace gestured a good deal to emphasize his points. When he spoke of the brain or the enquiring mind he gathered his fingers and thumb and touched his forehead.) And I should keep the inquiring brain. If ever I get to the point where I think that I have all the answers, then I am in danger of the Pharisee. Does it refer to the inquiring, testing brain? Try things out. Develop a hypothesis. Test it. And then do we often use that? How many people give this up by using alcohol and drugs that dull our reason? Is that the source of Bio-Social Evolution: the use of the brain?”

There is interplay between rigidity and flexibility. McAfee likes to illustrate this with the symbol of the airplane; for a plane to fly successfully there must be an optimal rigidity and an optimal flexibility.

             “Isn’t that a hard thing about life. We concentrate on the rigidity and lose the flexibility for new action when necessary or become so flexible that we throw out all the rules.
           “Now the Pharisees had a lot of good things. They were experts on the Torah, but they wouldn’t take in people like Peter, James, and John because they weren’t educated.
           “We need a figure of speech of continually reexamining our basic assumptions. Well, how are we to act unless we do have basic assumptions? We don’t say: ‘No, I haven’t looked into this so I don’t have anything to act on.’ If we’re always testing our basic assumptions, we hardly have time to act. Do you see a difficulty there all the time?
           “Does the movement or traveling metaphor help here? Today you find out a certain act was in conflict with your basic assumptions, and tomorrow you find another act is. In this way we become more clear about our basic assumptions. In the movement you become aware of your basic assumptions.”

How to change assumptions:

             “We speak of having these principles. Can we call these principles ‘God’? And then Jesus was spoken of as making these principles: ‘God’ manifest. This is the meaning of Christ. Each of us, then, can make these principles manifest in real life and each of us can become Christ. We’ve talked about concentrating these principles in this way.
           “Love and creativity are abstract concepts. They only take on meaning as they are applied in life. I should exhibit love towards others in life and creativity and firmness and the rest.
           “Should we have this idea expressed as a package? ‘To be essentially human.’ That’s the phrase Tillich used for Christ: The Christ is essentially human in all interpersonal relationships, not an abstract, off in the sky idea, but right here in everyday life.
           “Should we develop that ideal so that we have a value system on which to act? And develop an image of what a person would be like. Jesus, himself, said that you shall do even greater works. He did come up to his ideal and did a great number of good works. He may have done some bad things that weren’t reported. There are some things he is reported as doing and saying that I don’t think happened. I think that he was a very down-to-earth and joyous individual.
           “Is it better to take poetic metaphor literally than not at all? But then you don’t have poetry. You have magic.
           “To think: ‘God loved us so that he gave his only Son.’ If we could believe that, wouldn’t that have a tremendous effect on our lives?
           “I think that I’ve indicated that he did not die for our sins but because of them.
           “I mean that if you could believe that, wouldn’t that be very captivating that he died for you: Ted Whiteneck. Does that change your life for the good? Do people who can take that literally not seem to trouble over the things we trouble in?
           “Is it representative of all of us to some degree? When you take the statement: ‘No man has seen God at any time; only his Son can reveal him.’ I don’t think this means his flesh and blood. I take it to mean his value system. I mean these ultimate values we spoke of.
           “Then in this way Jesus reveals God’s values and concretizes it for us.
           “I picture Jesus as being very joyful. When you get this point of view, won’t it give us a great deal of vitality and joy in life?
           “And I don’t think he got his wisdom out of the air. This is an interpretation later. I think he led a small group, the twelve disciples, and he benefited from it too. I think when you feel this joy you want to share it. It has mutuality. I tell you and you tell me. Dialogue is a very important part of it.
           “Then group dynamics are very important here. It may be that Jesus had the twelve disciples to help him, and he helped them. This is the function of the Group.”   ⁹

McAfee describes how the feedback or influence of other Group members helps promote healthy change for individuals:

“We say, in principle: This is the appropriate or inappropriate thing to do. We say: ‘You are wrong in letting yourself become depressed or anxious.’ We are guilty for becoming depressed and we try to work a way out of depression by going out to others. This helps depression. Group says: ‘You are wrong in allowing yourself to become depressed, but our esteem for you has not decreased.’ ”

Depression often includes a sense of blame directed toward the environment. This may be life circumstances or other people. McAfee points out that we increase out Freedom by taking responsibility for improvement of our own well-being. When we are able to see our own part in bringing about and/or maintaining this emotional state, we can then assign and accept an appropriate amount of Guilt and work toward Forgiveness. By using techniques in the Group, such as Psychodrama, deep relaxation, or a controlled rage, a person changes their perception and subsequently their emotions and behavior.

             “Another case is when a person says: ‘So and so made me angry.’ Well, this is letting that other person have power over your emotions. That’s why we say: ‘I let so and so make me angry.’ He might have been a lowdown stinker and very mean, but that anger just hurts ourselves. We are working toward transmuting this anger to another constructive emotion rather than give in to these destructive impulses. We still want the energy, not just to allow ourselves to become dull and passive. I use the word ‘transmute’ rather than change or transform, because it involves a more essential shift in the emotional reaction.”  ¹⁰
            “Our goal is not to just grit our teeth and bare the hardship but to face how really hard it is and learn to rejoice and be glad for great is our inner reward. I take the words: ‘…rewards in the kingdom of heaven’ to mean our inner reward, not some place you go after death. But even inner reward is too passive. Maybe it should be: ‘reward in the Circle of Caring.’
            “The things we are talking about are not just the common things like stealing a piece of fruit or lying, but we’re talking about the deeper, more subtle things.
            “As I extend Forgiveness to another, I form a chain with them that extends to people of good will beyond and forms a Community of Caring throughout society. ‘Forgive us our debts as we Forgive our debtors.’ Then I stand here and receive Forgiveness as I extend it in reciprocal relationship.”

In the simplest explanation of Group process, like the gestalt law: the whole is greater (or of different quality) than the sum of the parts, we may say that several heads are better than one; at least there are multiple perspectives and sources for direction. We come together and share our life situations. Each person’s situation, to a degree, becomes a situation for all members of the Group. Suggestions and experiences are shared. We have not only our individual experience and knowledge to draw on but also all of our combined experiences.
           Another level of the process, then, comes into play. As each of us share our selves with other Group members, becoming better known, we find that these other Group members may have views of us that we do not have of ourselves. Other members may see areas of our lives that we are blind to. They may see how we are misusing or not fully developing our potential; we are acting in Compulsion, not truly exercising our Freedom. As this knowledge is communicated to us, we become aware of areas of Guilt. We have avoided or misused the Freedom that we could have developed. Sometimes this Group reflection is experienced as criticism, but it is based on a clearer view of our potentials. This is another paradox: what we experience as a critical view is actually a compliment. Our sense of Guilt only comes about because we have so much potential Freedom.
           Finally, an important process that is poorly researched, even in psychotherapy effectiveness studies, I am going to name “The Mirror of Empathy” or “Reciprocal Empathy”. It seems that intuitively we can recognize that providing Empathy and helping another person problem solve and grow individually, helps the helper. As I receive Empathy and Concern from others, my thoughts become clearer and my emotions energize me to improve my life circumstances and life-style ; my improved perspective helps me communicate these qualities to others—an epigenic prosess develops. (Remember Allen in Chapter 2: As he recounted his successes to others, it strengthened the new behavior: responsibility and positive self concept, helping the other residents consider their own.)
           The Group actualizes a growth process. How can we, members of the Group, help each other to see our potential, evaluate our behavior, experiencing Guilt where appropriate, not caught up in Compulsion but accepting Forgiveness and thereby developing Freedom, look toward life with new resolution, joy, and vitality?
            We are called on to act. Our ideal is to act with fullest knowledge: “Take all factors into account.” But we don’t have full knowledge and often our action is more critical than we realize. Paul Tillich writes:

Practice resists theory, which it considers inferior to itself; it demands an activism which cuts off every theoretical investigation before it has come to its end. In practice one cannot do other wise, for one must act before one has finished thinking. On the other hand, the infinite horizons of thinking cannot supply the basis for any concrete decision with certainty. Except in the technical realm where an existential decision is not involved, one must make decisions on the basis of limited or distorted or incomplete insights. Neither theory nor practice in isolation can solve the problem of their conflict with each other. Only a truth which is present in spite of the infinity of theoretical possibilities and only a good which is present in spite of the infinite risk implied in every action can overcome the disruption between the grasping and the shaping functions of reason. The quest for such a truth and such a good is the quest for revelation.

Systematic Theology, Vol. I, (219:93):

Our “quest for revelation” is Group insight leading to our work toward Forgiveness. The Group becomes the mediator of Forgiveness, representing The Good Society, understanding that there are ultimate values that we are developing. We do not know these fully, but we are working from hypotheses. We value individuals, even if they sometimes fail, realizing that to understand and correct failure is a practice of Forgiveness that helps us understand these ultimate values. In this way we begin a process that turns failure into success. Although failure can be immediately painful, it gives information about new directions. Each of us must act on our best hypothesis. Evaluation of the results helps us grow. Being accepted and valued, even during a failed attempted hypothetical action, strengthens our sense of self—we will attempt more creative interactions, stretching ourselves—risking new aspirations. Feedback both helps us evaluate and ground new actions; it also inspires. The understanding of others feelings and situations, along with the sense of acceptance, may be recognized as curative factors of Empathy and Unconditional Regard discussed in the previous chapter. Often there is a wide gulf between theory and practice, Group and life. One particularly powerful method of bridging this gulf is to bring life situations into the Group: enact them or re-enact them. We can investigate and experiment with them, relive situations from the past, and practice improved responses for the future—with a sense of play, fun, humor and Catharsis. This takes us to the next chapter Psychodrama.

NOTES Chapter Three

1 I have maintained the present tense as in the original for the rest of this section of Chapter 3. This is consistent with the time that this study was initially written as Group was meeting with the McAfees as leaders. Even after Wallace’s death, Group members met with Edna until her death. Many members continue to keep in contact with one another.

2 In an interesting conversation with Malcolm, Wallace and Edna’s son, he commented that Edna had studied group counseling quite extensively, and was an expert in this field herself. He gave me one of her text books for a group counseling course: George Bach‘s Intensive Group Therapy. Thanks, Edna for your (usually) gentle, reality oriented confrontations and coffee, tea, and the strawberry shortcake at the close of Group!

“I, I, I, I’ve become....... comfortably numb.”---from The Wall by Pink Floyd.

Since the initial writing, the American Psychiatric Association has recognized the chronic problems associated with these states with its diagnosis of Post-Traumatic Stress Disorder. (DMS IV). Footnote 14, Chapter 6 gives a few references to PTSD research done since Lifton’s groundbreaking work.

Remy Kwant writes: “...Through play the body and the world acquire for man a meaning which they do not have outside the sphere of play. One who does not at all, or only barely, knows how to play is blind to an entire dimension of reality. A child which has no opportunity to play often fails to grow up to fully mature adulthood. The non-playing man—if there is such a being—simply does not understand the field of existence, the world of the playing man...Let us add that man often plays with words, but it is also difficult to say of what this playing with words consists” Phenomenology of Expression (123:51). Remy has never heard of puns, or double entendre, or poetry? Come on now! His entire Chapter Four is “Expression and Playfullness”. Although insightful, it seems to have little fun or humor. Possibly he makes up for this in the next chapter with a footnote regarding an idea of Merleau-Ponty (123:102): “Le visible et l’invisible, pp. 185-187...Merleau-Ponty says that it is a typical Western phenomenon to make a problem of our knowledge of other human beings.” I take this to be tongue-in-cheek. Many of the various writings about humor or play seem somewhat devoid of either. At least Freud included jokes and wordplay in Jokes and Their Relationship to the Unconscious. Freud liked spoonerisms, one-of-which I recently came across in a book about the treatment of dyslexia: The host of a tribute luncheon for a local politician greets the honored guest: “Greetings Senator! Welcome to your recession!” While Freud might refer to this as a manifesting of an unconscious conflict, Dr. Sally Shaywitz (210) identifies this as a symptom of dyslexia for the person doing the greeting. Allen Watts, in a radio that I happened on recently, describes Chuang Tzu as one of the few major ancient philosophers that openly attempts to be funny. An example of the therapeutic power of humor are in transcripts of interviews with Milton Erickson, a favorite of McAfee’s. These often exemplify a fairly in-your-face hypnotic playfulness—and deadly seriousness—at times (89, 91)!

{A volume could be written on ‘peak-a-boo’ as a primal game, teaching consciousness-unconsciousness, identity, self-other relations, consistency of the world, surprise, change, transformation, humor, fun, control of those big things called parents or adults, along with a multitude of other concepts [Did you see (Will you see?) the two iis in experiiential? Boo!]}

(2017)I believe that he would have been interested in such approaches as single proton emission computed tomography (SPECT) and similar neurological imaging technics that have been developed in the last few years. Cf. Daniel G. Amen: Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness. for a popular presentation of these procedures. Wallace centered his attention on the client or Group member, in my experiences with him as a counselee and supervisee, than is evident from this interview (“Tell us what you think about this topic. Don’t be shy!”); where I elicited perspectives from him which was an unusual relationship for our discussions.

Joline had an answer to the issue of a name for Group, discussed near the beginning of this chapter. She liked “Fullerton’s Pharisees” (The McAfees’ office-home was in the city of Fullerton.). I take this as an example of the guiding philosophy Joline and I operated by: “Secular Humorism”.

PSYCHODRAMA

A dozen or so people meet once a week and talk. Many different topics are discussed, but they all seem to have relationships to the speakers and listeners. Even the most abstract ideas and speculations about existence and cosmology are communications about what we find meaningful to ourselves and one another. Granted, the relationships only become clear after repeated involvement in the discussions. New participants have been known to exclaim, “This is the weirdest thing I’ve ever been to in in my life!” Sometimes they smile quizzically and say, “This is just great! I’ve learned so much.” Then they never return.

A Group member is talking about a class in which she is having difficulty:

“The professor acts so damn haughty. He puts me down whenever I try to talk with him.”

Another person observes: “You sound angry.”

“Well, wouldn’t you be!”

From a third member: “We need a Psychodrama!”

A card table is brought into the center of the Group circle. Two chairs are set up across the table from one another and two more behind each of these. The principle speaker sits in one of the center chairs. She designates one of the male members of Group to sit opposite her. She describes her persecutor to him, believing that he can best play the role of her nemesis.

The Psychodrama begins as our principle player goes outside the circle then comes in and knocks on the table as if it was a door:

Professor Persecutor begins: “Yes? (Voice cold and detached) What can I do for you?”

Student: “Can I speak with you? I’d like to talk with you about the grade I got on my last paper.”

Professor: “Yes, uh, what’s the name?”

Student: “Shirley Martin.”

Professor: “Yes...uh.. (fumbles in the air as if with papers of some kind) ...It was a ‘B’.”

Student: “Could you tell me what was lacking from it being an ‘A’.”

Professor (with a very affected sense of disdain and exasperation): “You can talk with your T. A. That’s what they’re for. I have 800 students and I have to get this paper ready for publication next week. I don’t have time to bother with undergraduate’s problems.”

Student (quietly): “Oh.”

One of the other Group members, who has been listening silently but attentively, sits in the chair next to Shirley and states very loudly, almost yelling: “You goddamn piece of shit! I could get more help from a computer. In fact you’re nothing but a computer. I almost said: ‘living computer’, but that remains to be seen. You make me want to barf right here on your fucking desk!”

Hold the action!

It is clear why Group may sometimes appear ‘weird’ or even destructive to the uninitiated. Fears, anger, and other strong emotions are often the rule rather than the exception. Members often push one another into uncomfortable situations.

At this point I am going to step out of the arena to discuss calmly and carefully what we just had a taste of and why it is part of a process that is helpful to the participants. I am going to discuss the structure and function of Psychodrama, its philosophy and history: possibly ranging back to the Greek tragedies but as modern as the news you heard this morning. Following this description, I will discuss my own Psychodramatic experience, training, and use in therapy and training Groups.

Psychodrama was developed by Jacob L. Moreno who has also been credited with many innovations leading to the development of group psychotherapy including the name. Moreno claims to have conducted the first group psychotherapy in the early 1930s (158:17). Moreno calls Psychodrama “...the backbone of the third psychiatric revolution...” in which the individual treatments developed by Mesmer, Charcot, Janet, and Freud are moved out of the consulting room and made available for the treatment of society (158:151). Psychodrama is an extension of the techniques of hypnosis and abreaction, which the last four mentioned clinicians practiced and from which Freud developed psychoanalysis.

Although he was trained as a doctor, it may be a stretch to call Mesmer’s technique ‘clinical’. He hosted a French Age of Enlightenment salon, with a very theatrical flare. Mesmer practiced and possibly invented (or at least named) ‘animal magnetism’ (similar techniques described by Egyptian healers, including in the Bible, as well as Hippocrates, Asclepius and other Greek doctors—later becoming known by his name: ‘mesmerism’, then renamed :‘hypnosis’ in mid 19th century by Scots physician Baird). Mesmer would dramatically ‘magnetize’ a great vase-like or fountain-like device in the center of the room (called “The Baquet”) while his patients would touch this and fall into trance or ecstatic state of mind. They would awaken from this altered state of consciousness, often experiencing themselves as cured. Seeing as how he is generally considered to be the developer of modern hypnosis, we might consider him as an honorary clinician. His followers certainly considered him to be the genuine article! They claimed that he was instrumental in their recoveries [Richard Darnton: Mesmerism and the End of the Enlightenment in France (46)]. (Interesting to compare this ritual with the healing ceremonies of Pentecostal churches described in Chapter One, above.) Both Mesmer and Charcot practiced their hypnotism dramatically, in front of audiences, and seem in some ways, to be closer to the modern day stage hypnotist than actual ‘consulting room’ clinicians. Both had international reputations, Mesmer as a ‘magnetizer’, Charcot as a highly respected neurologist. Clinicians and other interested scientists traveled from other countries to observe and train with them. Freud studied with Charcot, while a century earlier Ben Franklin and Anton Lavoisier were part of a committee of world-class scientists who investigated Mesmer. (They were unconvinced.) Demonstrations by Mesmer and Charcot, however, can easily be credited as being progenitors of Psychodrama. The effectiveness of their facilitation of trance phenomena provides examples of Le Bon’s and McDougall’s descriptions, referred to by Freud in the first chapter, of ‘group’ dynamics practiced as hypnosis for purposes of healing. A more apt description would be: ‘crowd’ or ‘herd’ dynamics. Note the correlation of herd with animal magnetism. [Cf. Ellenberger Discovery of the Unconscious (59) and Pierre Janet Psychological Healing (107) for details of their ‘practice’.]

Moreno developed Psychodrama to the realms of very elaborate stage productions, involving a theater, three-tiered stage, special lighting and other special effects (158:108). In a small group this would be both impractical and not necessarily desirable. The sparseness of the props allows, even demands, participants imaginations to create the drama. With a few basic rules such as the ones described later in this chapter, several chairs and a table, Psychodrama may be produced with tremendous therapeutic impact for the participants, including the Group audience. This process also gives opportunity for spontaneity to develop, being one of Moreno’s main values. Psychodramas, while often dealing with topics in a life-and-death seriousness, are also fun, developed with a sense of play, these therapeutic ingredients emphasized previously and later in this paper. One of the main advantages, then, for our purposes, is the ability to reproduce and study elaborate social interactions when the need arises in our Group.

Lewis Yablonsky [Psychodrama: Resolving Emotional Disturbances Through Role-Playing (252) recounts participating in Psychodrama as led by Moreno in the late 1940s. Yablonsky was a graduate student at the time and this was his introductory experience. He attended a session led by Moreno and was called on to play what I term the Antagonist, although his role was not of a villianous or persecuting character. With no previous experience Yablonsky was called out of the audience by Moreno, who instructed him to play the part of the fiancé to a young woman who ultimately blew up and threw her engagement ring at him. (Quite a success!) Following this Moreno took the actual couple aside and worked with them therapeutically. Yablonsky describes Moreno as leading in a very charismatic fashion. The names Yablonsky reports of the roles played is slightly different than the names given in my study ahead, but how all of these roles are played is basically the same.

Psychodrama is part of a continuum with role-playing as the foundation. This may simply be defined as an individual pretending or acting as if he or she was another person. The role player can also act as themselves at another time, in another circumstance, and may be elaborated to playing and speaking for inanimate objects, for example rocks, stars, a river, a tug boat, a choo-choo (note the animistic connection to play and childhood), other animals or plants, or even abstract concepts such as Truth, Justice, country, Capitalism, The Unconscious, God, etc.

When a group of individuals interact, taking various roles, a drama is built up. Sociodrama is produced when dramatists play different roles representing segments of society. In a communications workshop given to hospital employees I had participants play different departments and discuss a SNAFU that actually happened when an oxygen tank was not delivered to the Eye Clinic, causing a delay in an operation, angering a doctor who verbally took it out on a nurse in another department. The players reported that they came to understand more about the complexities involved in coordinating many departments by acting out these parts. The stage was then set for problem solving. Role-playing is also the basis for an elaborate range of simulation games developed for education and industry as well as the government and military. ¹

In Psychodrama the roles played by participants are structured in such a way that the drama illustrates and works toward resolution of interpersonal and intra-psychic conflicts. As the technique is illustrated and explored, its use and methods become clearer.

In the remaining sections of this chapter I will discuss the structure of Psychodrama as I have used it with in-patient groups and staff training. This structure is derived from my own Group and Psychodrama training with Wallace McAfee. This pared down version of Psychodrama only vaguely resembles the Group event in full action. When members are very experienced and know each other well, Psychodrama becomes an important part of the working through process as well as a source of inspiration and new perspectives. The opening example for this chapter illustrates such an experienced Group. The inability of a newcomer to follow the action may, in fact, show the depth to which an experienced Group rapidly proceeds with this technique.

Figure 1

The center of Psychodrama is a table. There are two chairs set facing one another across the table with two chairs set behind and slightly to the side of the main chairs. This entire arrangement is set within the Group circle. The table functions in a ritualistic manner. Discussion around the table is considered to be taking place within the Psychodrama session. This has special features and rules and is differentiated from the usual Group interaction.

The two principles are the Antagonist and the Protagonist, designated in the picture above as “A” and “P”. The Protagonist is the person around whom the Psychodrama is centered. The Antagonist portrays the person with whom the Protagonist is attempting to explore and change communication and behavior. Usually Antagonist is the Group member best suited to act-out Protagonist’s demon or shadow, although there may be other portrayals possible. This is figurative language (no supernatural entity is meant) indicating a real life person that Protagonist finds particularly enraging or hard to handle in any number of ways.

There are times that a Group member might jump into the Psychodrama because they feel that they can best portray “A”. At other times “P” may decide or the Group may decide who can best play “A”.

Directly behind each of the principle players there are two chairs. These are for Alter-Egos: “Alt-Ego Pro” and “Alt-Ego Ant”. Usually these chairs are empty at the beginning of the Drama, but Group members fill them as the need arises. The Alter-Egos help the principles. Often “P” is stumped. This is the most common reason for a Psychodrama: “P” is stuck and does not know what to do, or “P” does not have a spontaneous action that works well for a particular social situation or an interaction with a specific difficult person. “Alt-Ego Pro” has more detachment and can support “P”. There are also times that it takes two Antagonists to set that particular Double-Bind that “P” needs to work out.

The action of Psychodrama is divided into two acts: Round 1 and Round 2. The use of names similar to parts of a prizefight may not be entirely accidental. In this case the prize is personality development. In Round 1 the object is to release emotion, usually frustration and anger. This process is referred to as Catharsis. Protagonist is encouraged to express rage toward the Antagonist. This may be in the form of yelling, swearing or even with bataka bats—foam clubs invented by George Bach who also developed Fair Fighting Therapy: methods of communicating anger, rage, and even, with these bataka bats, expressing physical assault, safely and therapeutically. Edna McAfee chuckled when I mentioned attending a workshop by Bach and his young women attendants. (Who beat each other up with Batakas! to the enthusiasm of watching clinicians. Not even sublimated sexuality!) “He was a great teacher; really funny!” she commented. Often genuine expression of feelings of rage is followed by laughter or sometimes tears. Most Protagonists repeat Round 1 several times, sometimes at weekly intervals, before Catharsis from an issue is achieved.

Round 2 is called Resolution. Its purpose is for Protagonist to practice a new, healthier interaction with “A”. Often discussion among Group members takes place during a “Time Out” between rounds. During this halt in the Psychodrama action, Group members discuss the interaction in order to figure out what a healthier response may be to “A’s” provocation.

Sometimes “A” and “Alt-Ego Ant” do such a good job at demonic portrayal that the entire Group seems double-bound! It often takes all of our wits working together, problem solving, to figure out a therapeutic or calm, healthy reaction or interaction during Round 2.

McAfee presents the idea that in Round 2 Protagonist can show that they hear and understand what Antagonist is saying. Protagonist may express or reflect the meaning of what the Antagonist communicates. Much of the practice that goes to make up Round 2 is developing a calm, reflective response to a situation that is originally truly maddening and/or provokes anger. Some Group members have come to call this “Second Round Response”. This is a process leading to empathetic communication. The goal is that the Protagonist takes the lead and is able to move the discussion with Antagonist to a calm equilibrium of emotion and thought. In Section C, Part 2 of this chapter and in the concluding chapter about the Crisis Intervention Workshop, some communication principles are presented that I have found helpful in explaining this part of the process. Psychodrama is a method to practice this assertive but balanced communication. If “A” angers “P”, “A” is in control of the communication. As “P” answers appropriately, even to provocations, “P’s” Freedom is increased. Commonly, the difficulty in formulating a Round 2 response centers on a principle that this response is not meant to be a capitulation. The usual response to a provocation is to become angry and argue. In Round 2 communication, “P” responds calmly, showing that he or she understands Antagonist but not necessarily agreeing or disagreeing. (Take a breath, and count slowly to three or ten—you’re the person in control of this conversation—or whatever number that you want!) Now explain “A’s” position—describe “A’s” experience, possibly even better than “A” can, him or herself.

The Round 1 action, as illustrated at the opening of this chapter, can become hot and heavy very quickly. Often, during a Psychodrama interaction, the audience members have ideas and want to chime in. With this high energy level, the interactions can become very chaotic. A Group member is designated as “Referee”: signifying when Psychodrama is “ON”, which round is taking place, and when Group discussion is appropriate and a Time Out is called. This person clarifies, in general, what is happening and has a certain authority to control the action.

Before proceeding with illustrations I would like to summarize with an outline then elaborate on each component. These include:

A. The Principle Interaction

1. Protagonist “P”

2. Antagonist “A”

3. Referee

B. The Alter Egos

1. Alt-Ego Pro

2. Alt-Ego Ant

C. Structure of the Psychodrama

1. Round 1: Catharsis

2. Round 2: Resolution

3. Time Out: Group discussion

D. Psychodrama and the Group

1. Individual–Group Effect

2. Group–Individual Effect

3. Presentation

A. THE PRINCIPLE INTERACTION.

This is the main body of the Psychodrama. We could describe this as The Plot. This is a portrayal of an interpersonal event in the life of the Protagonist, real or imagined. As the overall goal of Psychodrama, for the Protagonist, is to change an attitude, feeling, or behavior, toward or during this event, there is something uncomfortable, frightening, enraging, or generally not right about the interaction as perceived and acted upon. Sometimes this type of interaction by the Antagonist is called “crazy making”.

This event is brought directly into the Group by this portrayal. Examples of common themes include a teenager learning to deal with his mother’s authoritarian and demanding attitude without withdrawing or exploding in rage; a rehearsal for an upcoming job interview that was creating a great deal of stress and anxiety in a woman’s life; a second woman talking to her husband whose behavior she describes: “He tells people what to do all day (He is a supervisor.), then comes home, opens his beer and relates to no one but the TV. He expects me to punch in, fix dinner, and punch out. I’d like to punch him out!” Sometimes, as in the case with the teenager, more than one Antagonist may be played, in this case both parents. Even sibs and an entire family event has been acted out.

The real-life person who is portrayed by the Antagonists is usually not in the Group at this time. The presence of the actual person with whom the Protagonist has this difficult communication complicates full exploration and expression of feeling for “P”. Resentment, resistance, and inhibition result. At best, reality testing and rational explaining interferes with the full development of Round 1. The achievement of Catharsis comes from Protagonist being able to express what he or she is feeling without having to edit emotions for reality. Protagonists are often surprised by the expression of their own feeling. Experience teaches that Protagonist cannot gain the full level of rage that he or she may express if real-life Antagonist is present. (Admittedly, Moreno, in Yablonsky’s example, operated with both members of the couple present—the difference of a one-time ‘stage’ demonstration, and on-going therapy. Even in this example, Moreno took the conflicted couple aside and worked therapeutically with them.)

• THE PROTAGONIST : Since “P” is the person around whom the Psychodrama centers, I will begin by discussing this role. “P” necessarily will be part of the description of other roles, but I will return specifically to the interaction between Protagonist and the Group as a whole later in the chapter.

“P” brings an interpersonal interaction to the Group and requests help with it. Or, sometimes “P” is “encouraged” by other Group members to discuss and portray an issue. This interaction is often represented in projected terms: “My father’s giving me problems again.” Or “No matter what I do (he, she, they) find fault. I’ll never be good enough.” In our opening example the problem was Professor Persecutor. To “P’s” mind, Antagonist is symbolic of the entire situation. Psychodramatic presentation reproduces the projected symbol in as much detail as possible, allowing “P” to reincorporate it, thereby facilitating the opportunity for control.

At times a Group members describe general situations, e. g. “I hate school. It‘s so boring and overwhelming.” or “My job’s worth shit! (Profanity helps grease the wheels; we’re already well on the road to Catharsis.) I just can’t hack it, but I’m broke and it took me six months to get into this shithole job.” Question from the Group leader: ”Is there a particular person who’s pressuring you?” “Yeah! My boss is a real jewel. He gives me more than I can do then jumps all over my ass when I can’t keep up—then the job I do do sucks. I just want to tell him to stick it up his ass.”—and in 1st Round that is exactly what our speaker did. By personifying the situation with an Antagonist playing a superior such as a teacher or boss, a symbolic interaction is developed. Catharting toward the symbol catharts to the entire situation.

While projected, the issue appears beyond “P’s” grasp. This interaction may be restated in intra-psychic dynamics. The symbol: “Antagonist” arouses unpleasant, inappropriate, sometimes desperate emotions for “P”. “P” does not want to express these feelings to “A” in the real-life situation as this expression would certainly hurt “P’s” cause, and could, in certain situations, lead to “P” actually getting physically, as well as emotionally, hurt, or becoming so enraged that “P” might actually attack the person who Antagonist represents. Therefore “P” must devote a portion of consciousness, attention, or psychic energy (cathexis) to self-control as well as dealing with “A”. “P” does not want to “lose it” which could result in a reduced capacity for free, spontaneous interaction and increases the likelihood that “P” must rely on older patterns of behavior. These older habits are often not appropriate to the new situation or may be contributing factors to the present situation. These more primitive behaviors are emotion laden and therefore symbolic. It is now clearer that Psychodrama, a symbolic interaction, is effective because it is devised to deal with symbolic interactions.

I asked one of the actual Psychodrama participants, whose response that I have named Shirley Martin, what she was experiencing. (There are actually several Group participants, both men and women, who have done very similar Psychodramas. This is a summary portrayal, a common theme in Group with students, but also Group members describing work issues with uncaring supervisors, bosses, and other depersonalizing authority figures—often leading to parents.) Shirley describes feeling: “...completely emotionally clogged up. If I really let it out I’d just explode! I’d start sceaming at that arrogant son-of-a-bitch and never stop!” A couple of weeks later, in Psychodrama, that is what she did—attacking “A” furiously with batakas! Afterward she started trying to figure out what an effective Second Round might be. Until this time discussing Second Round just surfaced a good deal of anger.

• THE ANTAGONIST : The role of the Antagonist is on a par with playing the devil for “P”. Members who play “A” must ferret out what interaction “P” is anxious or angry about and do their best to portray this. “P” has an antipathy toward a certain person or sometimes several people in certain social roles. If Antagonist is successful he or she will encourage “P” to see them in that role. In communication theory: “A” manipulates the disjunction between verbal and non-verbal information or the contradictions and paradoxes that interfere with clear messages, to Double-Bind “P”, thereby entering into symbolic communication as “P” enters hypnotic or trance-like state of consciousness. Psychoanalysis might call “P’s” reaction a transference reaction.

As players come to better know each other in the Group, they become more aware of one another’s sensitive issues and highly charged emotional conflicts. By portraying these in a controlled Group atmosphere with a great deal of warmth and personal concern, Protagonist is offered an opportunity to bring up old and present (and even imagined future) hurts and work toward resolution. Although it may side-track the intensity of the Psychodrama, it can be pointed out that just First Round development itself requires a high degree of Empathy from the Group.

Player “A” also gains a cathartic effect by playing the Antagonist. In developing the character of the demonic, often hostile wielder of the Double-Bind, “A”, and the Group, must take an empathetic stance toward this all powerful antagonist. “We see what you’re really up to—and you can’t hurt us with your verbal attacks and lame attempts at control!”

With a small adjustment of the metaphorical Group lens, we also see potential powers and areas for growth for the entire Group. Often one becomes aware of others’ conflicts before one’s own may be faced. Sometimes a solution for another person clues us into our own solution.

In the non-Psychodrama Group interaction (Time Out) these conflicts may be explored and discussed, but if the discussion is too intense or the conflicts are presented too soon by being brought up in their full fury, between members of the Group, a stifling effect may appear on Group interaction. Topics will be discussed but afterward, in subsequent Group sessions, be avoided. At its worst extreme open conflict, backbiting, and sabotage occur. Unexpressed conflicts even attack Group cohesiveness and break the Group into factions. This may lead to the formation of in-groups and out-groups and the reliance upon authoritarianism. Ostracism and loss of members may occur concurrently with rigidity in those who remain yielding a Group dogma. The Group has, in effect, become similar, in form, to the commonly portrayed Antagonist: the internal conflicts of, and between members, are played out in projected form in Group interaction—regressing to the crowd—as individual members regress to primative defense postures.

We see that “A” is in an immovable position: the power of veto. Often “A” seems to project a self-righteousness and scathing tone of condemning judgment that devastates and reduces “P’s” effectiveness and power of choice dramatically. Jean-Paul Sartre’s phenomenological description of relations with the Other from his philosophical work, Being and Nothingness, gives voice to the horror of alienation that may be experienced by “P” at this point: “The lie is also a normal phenomenon of what Heidegger calls the ‘Mitsein’ (97). It presupposes my existence, the existence of the Other, my existence for the Other, and the existence of the Other for me” (205:49)... “The Other appears as being able to effect the synthesis between the unconscious thesis and the conscious antithesis. I can know myself only through the mediation of the Other, which means that I stand in relationship to my ‘id,’ in the position of the Other” (205:51). (An irony! Often Sartre is portrayed as an extreme critic of psychoanalysis. Here he uses its constructs (to attack it?). Possibly, he is portraying—giving life to—“The Other“ or as might happen in Living Theatre: “A” in your face!

Being beyond any knowledge which I can have, I am this self which another knows. And this self which I am—this I am in a world which an Other has made alien to me, for the Other’s look embraces my being and correlatively the walls, the door, the keyhole. All these instrumental-things, in the midst of which I am, now turn toward the other a face which on principle escapes me. Thus I am my Ego for the Other in the midst of a world which flows toward the Other. Earlier we were able to call this internal hemmorhage the flow of my world toward the Other-as-object. This was because the flow of blood was trapped and localized by the very fact that I fixed as an object in my world that the Other toward which this world was bleeding. Thus not a drop of blood was lost, all was recovered, surrounded, localized although in a being which I could not penetrate. Here on the contrary the flight is without limit; it is lost externally; the world flows out of the world and I flow out of myself. The Other’s look makes me be beyond my being in this world and puts me in the midst of the world which is at once this world and beyond this world. What sort of relations can I enter into with this being which I am and which shame reveals to me.

Being and Nothingness (205:350)

...in a shock that seizes me when I apprehend the Other’s look, this happens—that suddenly I experience a subtle alienation of all my possibilities, which are now associated with objects of the world, far from the me in the midst of the world.

Being and Nothingness (205:354)

At the same time I experience the Other’s infinite freedom. It is for and by means of a freedom and only for and by means of it that my possibles can be limited and fixed. A material object cannot fix my possibilities; it is only the occasion of projecting myself toward other possibles and can not confer upon them outside.

Being and Nothingness (205:362)

Thus myself-as-object is neither knowledge nor a unity of knowledge but an uneasiness, a lived wrenching away from the ekstatic unity of the for-itself, a limit I can not reach and which yet I am.

Being and Nothingness (205:367)

...my constant concern is to contain the Other within his objectivity, and my relations with Other-as-object are essentially made up of ruses designed to make him remain an object. But one look on the part of the Other is sufficient to make these schemes collapse and to make me experience once more the transfiguration of the Other. Thus I am referred from transfiguration to degradation and from degradation to transfiguration without ever being able to get a total view of the ensemble of these two modes of being on the part of the Other—for each of them is self sufficient and refers only to itself—or to hold firmly to either one of them—for each has its own instability and collapses in order for the other to rise from is ruins. Only the dead can be perpetually objects without ever becoming subjects—for to die is not to lose one’s objectivity in the midst of the world; all the dead are there in the world around us. But to die is to lose all possibility of revealing oneself as subject to an Other.

Being and Nothingness (205:394)

In our examples “P” is launched into feelings of helplessness and hopelessness. Professor Persecutor, our adolescent’s parents, the woman’s aloof husband all seem out of reach, in control beyond our influence. Such is the experience of alienation for Group members who take the Protagonist’s seat. You’ve always swallowed it all and its led to stress and strain. Such is the problem we must deal with to bridge a seemingly impossible chasm. ²

B. THE ALTER-EGO:

• Alter-Ego Pro: As all looks darkest in the old movies, the enemy is about to overrun the stockade; we hear the bugle of reinforcements. Although this scene has become a cliche to us on the screen, a highly idealized view of reality that seems to happen only in Hollywood, the process has validity for our Psychodrama (Remember: It is drama!). If we are to plunge the players into the depth of despair that they feel in certain real life situations, we must offer strength and hope for the process of change to come about. Such is the role of the “Alter-Ego Pro”.

It does seem to be true that the ego, while guarding against destructive forces, both blocks out but may also be the source of many healthful, creative impulses from within. ³ “Alter-Ego Pro” gives voice to these internal impulses toward life. The Alter-Ego Pro may out-reason or out-argue “A” while “P” feels overwhelmed with “A’s” seemingly omniscient logic. Better for Round 1 is for Alter-Ego to express the rage that Protagonist is inwardly holding, binding free emotional expression and consequently Freedom of behavior. In other words, Alter-Ego Pro BLASTS THE HELL OUT OF “A”. Alt Ego-Pro tells “A” what “P” really feels but has been careful not to express in real life as this would be too dangerous. “P’s” hidden fear is that expression of this rage may result in “P’s” loss of control, “P” being consumed in murderous anger or crushing “A” and as a result either being left with guilt and remorse or precipitating a fight that cannot be won (This being a fear left from childhood experience when adults were overwhelmingly huge—and potentially dangerous!). Often “A” is pummeled with batakas and more than one card table has been destroyed in both McAfees’ Group and on the Neuropsych Unit!

The dynamics of our opening example become clearer. As Shirley Martin’s voice lowers, “Oh,” is all that she can reply. She may be thinking: “He’s right. How stupid and thoughtless of me to bother him.” Or even simpler but closer to the surface: “Shit! Blocked again by that arrogant S. O. B..” Another Group member steps up to help, blowing Professor Persecutor away with a well developed barrage of rage and even obscenity. We now understand what this member has expressed. He or she (Did you imagine Shirley’s Alter-ego as man or woman?) is tapping an inner well of anger that somehow has been frozen, probably by training, trauma, and Double-Bind hypnotic programming: “...good girls and proper ladies never even think of getting angry and are always helpful to those big, important authority figures... You are a proper lady, aren’t you?” etc.) Shirley can now rally and take over from her Alter-Ego. As her expression is found, Shirley feels her own strength develop and she begins to perceive her Antagonist as the small, less powerful presence that he is. She may also begin to experience the rage that troubles her, saps her energy, undermines her self confidence, and results in her withdrawl and sense of helplessness. Often the Protagonist takes over with statements that leave the Alter-Ego Pro’s screaming rage sounding like a recital of a sacred catechism—the quiet melodious chants of distant monks. The Alter-Ego representing the members of the Group is here to *POWERFULLY* cover Protaganist’s back. Possession may be what has been the controlled, sub-conscious rage—held in so tight—but now, suddenly let go.

CATHARSIS!

Much of our impotence in the face of this rage comes from our isolation and our sense of alienation. As we receive empathy of other members of the Group, we also receive a sense of Forgiveness for the Guilt that we feel, the awareness of the emotions that have bound this rage within. While the Group extends Forgiveness, the members are also helping Protagonist work to develop a strengthened sense of self.

The Alter-Ego Pro is the ally of the Protagonist representing the strength of the entire Group helping “P” toward the climax of Round 1, the Catharsis. As “P” is experiencing Guilt for the boggled interaction, the Group is beginning to extend Forgiveness.

To play these roles successfully, Group members must develop greater depth of empathetic understanding. Playing the role of Alter-Ego is helpful in itself. The Alter-Ego player may also gain Catharsis by expressing “P’s” extreme feelings. This is especially true when the role played by Antagonist for “P” is also close to an actual person toward whom Alter-Ego Pro and members of the Group audience experience conflict. Group members in the audience of a Psychodrama may also experience Catharsis This is similar to the experience described by the ancient Greeks resulting from observing an enactment of drama or certain cult rituals.

• Alter-Ego Ant: Briefly, the Antagonist’s Alter-Ego functions in a parallel way to “A” as Alter-Ego Pro does to “P”. Occasionally two or more voices may help to establish the Double-Bind or feeling of being trampled. ⁴ This is the experience that “P” is working to resist.

At times an Antagonist player feels uncomfortable being as mean to “P” as is required to enact a conflicted interaction. The Group members can come up and help, playing auxiliary Alter-Ego Ants, when they feel demonically inspired enough.

C. STRUCTURE OF PSYCHODRAMA

As can be gathered from the preceding, Psychodrama is a method which can be used for emotional release and to improve on very difficult, often dangerous, inner attitudes. It also is a type of rehearsal for improved reaction and communication in difficult social situations. Because of the potential danger involved, it is important to set a definite, firm structure to the action; this is to give safety to the participants and also give security to the person who takes the seat of the Protagonist. If these impulses that we are calling up have been rejected from consciousness and expression previously, there is no reason to think that a participant will allow their expression without, at least, a certain method of control available.

The role-playing is divided into two rounds with Group discussion at appropriate times during Time Outs. So far, the First Round has been described in the most detail. The Second Round is of equal if not greater importance. Sometimes the First Round is carried out more easily because it is often highly energetic, even entertaining, and does not require the concentration and work of the Second. Philosophically, we do not see that the goal is merely to help Group members become aware and express their dark side and then go on their way being able to assert themselves, expressing anger toward anyone with whom they feel a bit annoyed. In fact, it is made clear to the members who take the Protagonist seat, that if they can fully express their inner anger during Psychodrama, they will feel and be controlled by it less in real-life interactions. Firm instructions are given: “The anger you feel toward-----(mother, father, boss, lover, husband, wife, children, therapist, …fill in the blank…) is to be expressed here, not directly to them (except possibly therapist).” This adds to the security that allows fuller expression during the Psychodrama. ⁵ For this reason there is an injunction regarding marriage partners participating in Psychodrama together except when role-playing an outside event, for instance, a wife acting the part of her husbands employer or verse visa. (Although sometimes husbands or wives can act the part of parents or in-laws. These portrayals can be very fruitful for couple and family therapy but require very careful refereeing by the therapist. Role-playing, itself, is a very effective technique to teach and practice new, growth enhancing communication interaction with couples.)

Round 2 is a Resolution phase. The many theories of therapy that hold that insight, self-understanding, satori, field-ground shift, or various types of ‘ah-ha’ experiences are enough for improvement are incomplete. Certainly the perceptual shifts that accompany these revelations are gratifying and important, but they lead to the next step. First Round completed ushers us to the door of the Work Group. Practice of a new interaction takes us inside.

Before we cross the threshold, let us understand an important part of the structure in which we are working. It seems that Second Round is more productive after full experience of Round 1. I will elaborate on the important process of Catharsis before venturing onward.

1. ROUND 1 -- CATHARSIS:

Carl Rogers writes of Catharsis:

Catharsis . Another psychotherapuetic approach of ancient lineage is the technique of confession or catharsis. The confessional has been used by the Catholic Church throughout many centuries. It has allowed the individual to talk out his problems to an individual who provides a certain defined type of acceptance. Both the Church and individuals outside the Church have found this method helpful. Psychoanalysis has taken this concept of catharsis and made much deeper use of it. We have learned that catharsis not only frees the individual from those conscious fears and guilt feelings of which he is aware, but that, continued, it can bring to light more deeply buried attitudes which also exert their influence on behavior. In recent years we have learned new ways of using this old approach. The whole technique of play therapy is based on the fundamental principles of catharsis; the use of finger paints and psychodramatics and puppet shows all have a relationship to this old and well-established category of psychotherapy.

Counseling and Psychotherapy (190:21-22)

Freeman, Sadock, and Caplan define Catharsis:

Catharsis; Release of ideas, thoughts, and repressed materials from the unconscious, accompanied by an affective emotional response and release of tension. Commonly observed in the course of treatment, both individual and group, it can also occur outside of therapy. See also Abreaction, Conversational catharsis.

Modern Synopsis of the Comprehensive Textbook of Psychiatry (67:757)

I would also add two other views, one ancient and one modern. These are even more to the point of the experience. Philip Wheelwright, in his synopsis of ancient philosophy, The Presocratics, writes:

…the idea of katharsis (purification as the washing away of unnatural and injurious superfluities), whatever its drawbacks and uncertainties in relation to effective medical practice, became in its metaphoric extensions a powerful and indeed an archetypal idea in the formation of religious imagery and myth.
…a symbolic act of katharsis is called for—not as a washing away of physical blood or any other physical superfluity, but as a symbolic and penitential removal of something that is morally evil.
The penitential character of katharsis, which thus involves ritualistic and spiritual absolution, becomes further developed, particularly in the Orphic tradition of ancient Greece, into a notion of washing away of sin generally, the washing away of one’s personal and tribal past or of some repugnant aspect of it. The higher forms of mystery religion, such as the Eleusinian cult, conceived of cult-initiation in this manner. The initiate renounced with proper ceremonies his old life and solemnly received admission into the inner membership or the cult. And such initiation involves a further result of deepest importance. For as the religious initiate sheds the husk of his former life and enters fullheartedly into a shared life of the cult, he acquires not only a new pathos but a new gnosis as well: which is to say, he steps not only from a state of being which is evil and unhappy into one that is blessed and pure; he steps also, according to metachthonic doctrine, from the darkness of ignorance and confusion into the light of true and divinely revealed wisdom. The higher rites of religious initiation all involve in some way the assumption of a new gnosis opened up to the initiate by his conversation.

The Presocratics (240:22-23) ⁶

This view also establishes the need and purpose of the Second Round. This is the Resolution, the healing part of the ritual in which the “new life” is practiced.

Some Groups, whose structure is derived from Alcoholics Anonymous, develop ritual reminiscent of Wheelwright’s characterization and tone of the Eleusinian Mysteries: the recognition of the need for penance (Hello. I’m ------. I’m an alcoholic.), the Twelve Steps and recitation of how a member applies them to their lives and interactions with others being the ceremony of membership—the derivation of Catharsis.

The common way that the term catharsis is used in the medical field today is also very relevant. To the Medical staff, in the hospital, a catharsis is a synonym (or floor slang?) for a bowel movement, usually referring to the relief obtained after a bout of constipation. If we can imagine the Protagonist suffering from emotional constipation–often many years standing—we can also glimpse how good and even freed up “P” feels after full Catharsis. In more concrete, behavioral terms, Protagonist is encouraged to let his or her buried anger and rage fly. Yell, scream, pound the table, hit the Antagonist with batacas. Let it all out! Yeah! “P” is now ready to try a new approach to that old impacted interaction.

2. ROUND 2 -- RESOLUTION:

After the full expression of pent-up feelings, “P” experiences more freedom of action, perceptions, and emotion. After successful Catharsis an individual is more aware of the feelings and needs of others. We may say that “P’s” interaction has moved closer to the Golden Rule: “Do unto others as you would have others do unto you.” Rather than the other subtle maxims with which it is often confused: “Do unto others as you would,” or “Have others do unto you as you would have others do unto you.” “P” is now beginning to work toward the process that Wallace McAfee describes and names “Becoming Fully Human”; Maslow’s description of Self-Actualization (SA) includes examples of some of the qualities of the person who he describes as the: “Fully Developed Human”:

To summarize, SA creativeness stresses first the personality rather than the achievements, considering these achievements to be epiphenomena emitted by the personality and therefore secondary to it. It stresses characterological qualities like boldness, courage, freedom, spontaneity, perspicuity, integration, self acceptance, all of which make possible the generalized SA creativeness, which expresses itself in the creative life, or the creative attitude, or the creative person. I have also stressed the expressive or Being quality of SA creativeness rather than its problem-solving or product-making quality. SA creativeness is “emitted,” or radiated, and hits all of life, regardless of problems, just as a cheerful person “emits” cheerfullness without purpose or design or even consciousness. It is emitted like sunshine; It spreads all over the place; it makes some things grow (which are growable) and is wasted on the rocks and other ungrowable things.

Toward a Psychology of Being (144:145)

We also envision “P” moving toward a healthier balance of the poles of Erikson’s identity stages, discussed in detail in the last chapter. As I have suggested earlier, these changes do not follow automatically. As all habits, destructive as well as constructive, have taken many years to learn, we cannot assume that, just because harmful habits are expressed and fully understood, healthy habits will suddenly appear. Often the most difficult, and potentially fruitful, part of the Psychodrama is Round 2.

Antagonist once again attempts to double-bind “P”, but “P” is able to respond in a fresh way to “A”. “P” listens to “A” and responds with understanding. “P” does not argue with or berate “A” but listens to what “A” is saying and responds in such a way that “A” feels understood. As Group extends Forgiveness to Protagonist, Protagonist extends Forgiveness to Antagonist. This is no easy task, especially when “A” is laying guilt and rage really thickly onto “P”. “P” is taking responsibility for the interaction with “A”. There are three levels on which“P” may respond to “A”:

1) Facts, 2) Feelings, 3) Empathy.

1) Facts: “P” may reflect or talk with “A” non-committally about the subject matter that “A” is discussing. Methods of expressing understanding of facts include repeating ideas back to clarify meaning or carefully reframing to emphasize features important to “A”.

2) Feelings: “P” may reflect, showing an understanding of feeling that “A” is expressing.

3) Empathy: Communication of facts and feelings leads to communication of empathy. Protagonist may communicate an understanding of how Antagonist is experiencing the issue(s) that he or she (“A”) is discussing.

The reason behind this style of response is that “A” is attempting to Double-Bind, holding power over “P”. (“A” may not admit to this.) ⁷ If this is the case, “A” is angry, uncomfortable, insecure or even harmful or sadistic. Therefore “P” is the most rational, responsible individual in the interaction. “P” may be able to help “A”. If “A” is openly irrational and angry, this is not a good time for “P” to press his or her own point, even if this point is technically or factually correct.

Examples of possible Round 2 responses follow:

1) Facts: Rather than withdraw, Shirley Martin could answer Professor P: “Wow! It sounds like you're really busy.” She then might engage him in conversation about how the grade standards were set. Even if he did not directly give her the information she requested, she may find an answer to her question in a discussion instead of getting in an argument that would certainly not serve her purpose.

2) Feelings: An adolescent may reply to his parent’s demand to know where he has been all night with the reply: “You seem worried about me.” This may also be an opening for further conversation. Although Group members and the therapist may agree with the parents’ concerns, establishing clearer communication between parents and adolescent is the initial goal at this point. The Group may have an opening here to explore “P’s”, i. e. the boy’s, feelings. These issues may include his reaction to responsibilities, sense of rebellion or needs for individuation, and even response to his parents’ communication of rational authority. Parents responding with comment on the boy’s feelings may also be an introduction for their communication of concern.

3) Empathy: A wife whose husband withdraws in front of the TV has a difficult job starting conversation with him. It’s easy to become discouraged or angry. Rather than react with anger and depression, she may break the ice with: “I’d feel exhausted if I had all the responsibility that you’re faced with all day.” Sometimes such recognition will soften an armored stance and conversation may continue. Recognition of stress that another person experiences may be an invitation to talk. Even if the husband does not immediately respond, repeated replies may impress him beneath his conscious level of awareness. [Note 2009: I recently viewed a training video for police and correctional officers for California Department of Corrections and Rehabilitation as part of an inservice training. It presented this issue, the marriage partner, usually husband, but now more frequently the wife or both, with a high stress and high stimulii occupation, who comes home and does not want to interact. There are many small types of communication that can open up conversation after a rest and re-entry period. Rest, meditation, a nap or stress reduction-relaxation exercises, or just quiet time, is important before the demands of family and socialization (even pleasant ones) present themselves. Empathy, in this case, is an evaluation of the situation and a plan with which to start experimenting with supportive communication when the time is right.]

The Group can support the woman while she tries to improve communication by practicing an empathetic response. Following similar Psychodramas, I have witnessed several instances when Protagonists have found that, once their anger has been vented and reduced in Round 1, they have been able to communicate much more directly with the real-life person that Antagonist modeled. A man who came to Group with his wife after a long series of arguments, practiced Round 1 for several weeks and then one long Round 2 session with other Group members. (His wife was not in these particular sessions.) Following this he reported that he was able to tell his wife something to the effect of: “This has been miserable for you. Let’s talk together now.” He said that he felt calm and even friendly toward her. Because the tension had been reduced his demeanor was straight forward. Conversation continued without enmity or an overload stress.

These are not easy responses, especially when a person is the focus of another’s anger and accusations. They may develop conversation, however, rather than ending one in argument. These are only opening responses and the dialogue often must be extended. They represent a tone of approach. This is the work of Round 2. It often takes the entire Group to develop these responses and then practice them in Psychodrama. The Group practices empathy and support for “P” as “P” practices new interactions and sometimes deals with rebuff from real life Antagonists that has taken place outside the Group. This is therapeutic work for all members.

What we are developing and practicing is constructive communication. The Group is there to help practice these responses as well as promote communication. The point of these comments is to turn blocked and hostile communication into an interaction with some resolution. The temptation for “P” to set themselves right and “A” in the wrong should be avoided even if this is truly the case (or appears so to “P”). These replies must be given with an understanding tone of voice. Any tinge of anger on “P’s” part will give the impression of sarcasm or mockery.

Practice of Second Round interaction in Psychodrama leads to a Group discussion about methods and strategies for the person playing “P” to deal with the real-life person or situation that “A” is meant to represent. It is not easy to develop Round 2 responses and for this reason full Group discussion between rounds is necessary and important. As individuals of Group come to know one another, members become aware of one another’s potentials, as well as the blocks that are the ingredients of future Psychodramas. This is an opportunity for all Group members to work with “P” to develop untapped sources of healthy feelings and responses toward others. This helps “P” and all Group members to develop these responses.

Sometimes Round 2 is seen by Group members as “P” giving in to “A’s” demands. In fact this has often been the topic of Group discussion. Wallace McAfee addresses this issue in his interview in the previous chapter. Capitulating or giving in to “A” is not the purpose of this process. “P” is to take a more integrated, more mature view of interactions; “P” should not do what “A” wishes if this would be improper but instead communicates understanding to “A”. If “P” feels that this is giving in, “P” may still be harboring wishes to fight with “A” and a return to Round 1 is indicated. It is not unusual for “P” to practice a Round 2 and discover a new well of anger and, therefore, return to First Round. “P” may have initial experiences in Psychodrama where he or she feel enraged, even out-of-control. First Round may also surface feelings of despair and hopelessness: e. g. “ If you don’t agree with me, I feel panic or enraged!.” (This may lead to a Time Out to discuss the source and how to calm these feelings.) After several episodes of Psychodrama and much support from Group, “P” begins feeling a sense of wholeness, personal strength, and integration. “P” is the person in control during the interaction. “A” can remain belligerent towards “P”, but that’s Ok! “P”, with the strength of Group, is calmly extending a sense of Forgiveness to “A”. “A” is calming down and at least beginning to feel a sense of empathy from “P”.

D. PSYCHODRAMA AND THE GROUP

Psychodrama is a very lively event in the Group. It involves all the members in one capacity or another. At this point I will discuss some of the trends that take place on the group process level.

1. INDIVIDUAL-GROUP EFFECT: Although it is most obvious that Psychodrama re-enacts an interpersonal situation, it may also be viewed in psychodynamic terms. The Psychodrama may be described as a re-creation in space and time of what is taking place in the mind of the person playing the Protagonist. In psychoanalytic metapsychology, “P” represents the ego, “A” the punishing super-ego or the irresponsible, over-demanding id. Sometimes Antagonist seems to be both of these voices at once, a clear characterization of a Double-Bind. (In Beyond the Pleasure Principle and the studies that followed in the late 1920s including GP&AE, Freud indicates that the source of the super-ego is closely tied to the id.) At best, Protagonist responds with self-protective rage. If “P” becomes stumped or overwhelmed (mystified, dissociated, intimidated) by “A”, Alter Ego-Pro gives voice, in the First Round, to those preconscious drives toward health that have festered into rage from repression. “P” being effectively placed in a helpless position, is even reminiscent of Freud’s description of the ego:

The proverb tells us that one cannot serve two masters at once. The poor ego has a still harder time of it, it has to serve three harsh masters, and have to do its best to reconcile the claims and demands of all three. These demands are always divergent and often quite incompatable; no wonder that the ego so frequently gives way under the task. The three tyrants are the external world, the super-ego, and the id.

New Introductory Lectures on Psychoanalysis (77:108)

Whereas psychoanalysis often leaves humanity in this rather suspended state of tension and helplessness, this use of Psychodrama seeks to go beyond these constructs and may be following Freud’s more hopeful dictum:

For (the psychoanalyst’s) object is to strengthen the ego, to make it more independent of the super-ego, to widen its field of vision, and so to extend its organization that it can take over new portions of the id. Where id was there ego shall be.

New Introductory Lectures on Psychoanalysis (77:111-112).

In Round 2 the tenor of the Psychodrama changes. Rather than a helpless ego, whose ultimate goal is to give voice or defend against the angry id, often with incoherent rage, “P’s” goal is an integrative one. Alter-Ego Pro’s goal, similarly at this point, is to help reinforce Protangonist’s new perceptions of Antagonist. “P” practices seeing and interacting with Antagonist as an equal, not only as a pitiful child barely able to protect oneself or as an enraged contender who must crush “A” in order to possess the tremendous power that “A” seems to possess.

This practice of Psychodrama, then, is a fundamental extension of a basic psychodynamic-therapeutic viewpoint. It allows the individual, with the help of the Group, to communicate with and change relations with problematic parts of the self. Often defined as repressed or unconscious, these drives are usually difficult to bring to awareness. The entire Group, when involved in Psychodrama, is a symbolic representation of the workings of our central player’s mind. Even during Psychodrama, however, the Group maintains its own integrity. This lends a sense of strength and organization to the central individual.

2. GROUP-INDIVIDUAL EFFECT: The concept of space gives an interesting comparison between the effects on the individual of the usual Group interaction and Psychodrama. When a Group member is speaking about themselves while sitting on the periphery of the Group circle, he or she may talk to individuals across the Group as shown in Figure 2:

FIGURE 2

A Group member may talk to several other members:

FIGURE 3

There is also a possibility that other Group members may talk to one another about a third member, leaving them an observer:

FIGURE 4

During Psychodrama the rules of the game structure the conversation so that the central individual (“P”) must recreate, using the Group members as players, the subject of his or her communication. This actually places the Protagonist at the center of the Group, physically as well as symbolically:

FIGURE 5

“P” (returning to our opening example, Shirley Martin) is allowed and encouraged to reproduce her own thoughts and mental scenes with the help of of Group members. She is involving them in her thought process. “P” incorporates this with the Group process in this manner. These procedures are also structured by the rules of the game. In Round 1 “P” is confronted by her Antagonist. She responds poorly. Her inner feelings only confuse her actions and perceptions toward this imagined person. With the help of her Alter-Egos she develops a strengthened response: anger and rage instead of passive withdrawal. Sometimes this act must be repeated many times, like exercising a muscle to improve its strength and tone. A cathartic effect is achieved that seems to drain the rage and anger and unblock these tangled feeling toward the person she experiences as her tormentor. As she expresses these emotions, she communicates an experience that has been largely rejected from social communication and consciousness. The members of Group respond in an accepting, therapeutic manner of empathy and warmth but also with a challenging attitude. In later Psychodramas she takes on the Antagonist herself. (She may have gone on to other problem people in her life, often more personal, often parents.) In this way the Psychodrama experience strengthens her sense of self.

In Round 2 “P” practices a stance of viewing the tormentor with heightened reality and appropriate emotions. This action is also encouraged even shepherded with the help of Alter-Ego Pro and the empathy of the entire Group. In this enactment the person who plays “P” also discloses herself to the Group. In these ways “P” becomes more fully a member and receives the strength and healing forces of the entire Group on deeper levels of herself. Group members who form the audience and Alter-Egos work on their own issues vicariously as they work to help “P”.

It is essential that the trend of the Group is toward improvement and health. There is a high probability that in a group characterized by destructive values or alienation, (This may be a contradiction: Can a “Group” be characterized by alienation? A highly competitive classroom situation with instruction to interact as a supportive group might fit this discription and is likely to produce aberrant fruits. “Let me help you cross this street by pushing you into traffic.” (Or at least publically embarassing you.) “This is for your own good.” “This hurts me more than...” You know the rest [ref. “double-bind”, “mystification”, R. D. Laing: Politics of Experience, Self and Others, (127, 128, 129)]. Cf. chapters on mystification and collusion. “P” may come out worse for the experience. ⁸

There are instances when the actual person represented by “A” is intractable or as McAfee might assess: Compulsive, to the point of needing a large portion of Excuse. This does not mean ignoring them. They may be in a power position or even dangerous to “P”. In extreme cases they may expect “P” to carry out dangerous or unethical behavior. At this point I recognize these potential issues and recommend that this be a discussion in Group. These may be times when other authorities or consultants should be involved. Role playing allows rehearsal for these extremely difficult interactions and the involvement of others as distant witnesses may be helpful. Discussion of dangerous situations which may involve legal issues, administrators on jobs, parents for juveniles—as well as experiences adults may have had as children in similar situations—are forms of empathetic understanding that the entire Group participates in. These portrayals can also be developed into role plays for problem solving.

3. PRESENTATION: The actual implementation of Psychodrama in the Group does not run quite so smoothly as implied by just reading the theory. This is especially true with a Group of inexperienced players. Initially, when I teach and demonstrate Psychodrama to a new Group, I set up the chairs as in Figure 1 and briefly explain what each of the parts is to consist of. Sometimes I stand by the chairs and even act out a prototypal Psychodrama, playing all of the parts. This actually presents this movement oriented action technique for Group members to model.

Instead of using terms like Protagonist or Antagonist, which are derived from Moreno’s original terminology which, in turn, comes from classical drama, I describe the roles in common language such as “Hero” and “Villain” which come from classical melodrama. I then describe the two rounds. In the First Round the Villain is to make the Hero angry and the Hero has a chance to vent. It is important for the Hero to express rage. If the Hero cannot get angry, then members of the audience come up to the table and help. I make a point that the anger is to be expressed only in the Group and not taken out on the actual person who the Villain represents. If the Hero was to leave and blow up at the Villain’s real-life counterpart, it would be acting on only half the Psychodrama and would likely make the relationship worse.

Once the Hero has vented and released some of this anger, he or she is ready to practice Round 2, designed to improve relations. I now present my version of active communication: reflecting 1) Facts, 2) Feelings, 3) Empathy with Villain. I also explain that this is probably the most difficult part of the Psychodrama and will require much work and Group discussion.

I present a Psychodrama using a fictitious example. I play all the parts or have members sit in the chairs while I stand behind them and speak for them. In producing the example, I try to use what seems to be a focal issue for all Group members. This increases Group Cohesiveness as well as personal interest. The Hero-Villain terminology also activates certain archetypal themes facilitating Universality. Some examples of these themes that I have used for demonstrating Psychodrama in psychiatric hospital in-patient Groups include husband-wife interactions with a Group largely composed of depressed wives or alcoholic men, or depressed husbands and alcoholic women. (Sometimes its hard to tell the difference! This may be an area to experiment with role reversal.) Other themes are parent-child interaction for Groups of adolescents and young adults. If the members are sensitive to the issues, I have even done Psychodramas with psychotic patients, although the roles and themes must be much more closely tailored and controlled with the leader keeping track of boundary issues and keeping the interaction at a level that the patient can understand or not misconstrue too badly. I have seen ‘psychotic’ responses in Group that actually initiated new, fruitful directions of discussion.

Initially I try to portray the Villain as a real jerk: “A Number One Asshole.” Yes, swearing is encouraged and is an important part of Round 1 Catharsis, often almost lubricating the process.. A breakthrough came in one in-patient Group when a very withdrawn young woman was able, with much encouragement from other members, to yell at the person playing her mother, calling her: “Bitch!” This was after two weeks during which time she called the nurses “bitch” with little hesitation. This usually happened when she did not get her demands met immediately by the nursing staff while she was an in-patient. She was discharged from the hospital much improved, a week later. She had made some fairly important life decisions which seemed to the staff and her psychiatrist to be in a positive direction. These included Second Round rehearsals for meeting her mother in family Group described below. I do not claim that Psychodrama was the cure. She had many different forms of treatment while hospitalized, but it appeared to help her communicate in the daily patient Group sessions. Her more extraverted and accurately placed expression may have been indication that she was improving psychologically.

I often show the Villain as initially winning the battle and then demonstrate the Hero’s Alter-Ego coming to the rescue and reinforcing the Hero. Then the Hero takes over and ultimately is successful with expression of anger or rage.

I make a point of the importance of Round 2. Round 1 is cathartic, generating interest and energy it can be fun and highly motivating. Occasionally the audience cheers a sincere Round 1 cathartic portrayal or an important breakthrough such as with the young woman just cited. Round 2 requires concentration and is work, albeit creative work. Round 2 definitely has its benefits and satisfactions. The withdrawn woman who I just described practiced ways to tell her mother “No!” when the Antagonist playing her mother attempted to boss her. She had to practice saying “No!” in a non-alienating manner.

I present examples of possible Round 2 responses. The Hero neither agrees nor disagrees with the Villain but listens and replies with reflection of Facts, Feelings, or Empathy. I will present an example from one of the Psychodramas in which our withdrawn woman participated. (Call her “Janet”.) This is a Round 2 interaction with another patient playing her mother and eventually an alter-ego helping. Round 1 has already taken place. After several practice Round 1 Psychodramas during the previous days, Janet was able to yell loudly, even hitting the table with fury. This was directed at another patient playing her mother as Antagonist. Janet surprised the Group with a barrage of very insulting swear words. Group discussion included empathetic responses from other members about issues with their own mothers or their roles as mothers. These led to a discussion about Janet’s mother’s mixed motives; her “help” had a high price for Janet. It too often fostered a debilitating dependency. This Psychodrama attempts to deal with this issue:

M (Antagonist as Mother): “When you get out of the hospital you can stay with me.”

J (Janet): “Mother! I told you that I was going to stay with Sally. (Sally is a collegue from her work.) She has...”

M (Interrupting): “You know that’s not going to work. I have room. You don’t have to pay rent and can get on your feet. You don’t have to go back to work right now.”

J: “Stop!....I can’t deal with this.” Janet is visibly upset. I ask her to take some deep breaths and put the interaction out of her mind for a minute or two.

After a Time Out during which the Group discussed whether a return to Round 1 may be needed, Janet decided that we should continue with Round 2 and an Alter-Ego to help her speak calmly to “M”. In previous Groups, especially during Round 1, Group members had noted how much of “M’s” communication was disconfirmation of “J’s” competence.

M: “You know that the stress is too much for you. You’ll just end up back here.”

Alt-Ego J: “Thank you for all your concern and offers to help, but I’m a lot calmer now than when I came in. I’ll be fine. You don’t have to worry.”

TW (group leader, to Alter-Ego J): “You don’t have to explain or waffle around.”

The psychiatric nursing staff had had previous treatment discussions and the consensus was that Janet needed help focusing her anger on its source rather than on them. Helping her set boundaries and making her own decisions was a part of Janet’s treatment plan that I, as group leader, was trying to accomplish. The other patients also seemed to understand this intuitively and played their parts effectively as alter egos or giving Janet encouragement and support. Most of the patients had met Janet’s mother and watched them interact during visiting and Patient-Family Group.

M: “Yes. Why don’t you just come home?”

Alt-Ego J: “I really appreciate the offer. You’re really trying to help, but I..uh...(rushed) I don’t want to!”

(Group laughter.)

TW: “You don’t have to explain, even if it seems that she demands it. Just keep answering by reflection. See if you can just acknowledge what she said by repeating it back. It’s OK to be repetative. It’s like you’re trying to drain off her bossy energy without a fight.”

After Group discussion of what reflection would be like.

M: “Just come home with me. You’ll be fine.”

Alt-Ego J: “I appreciate your concern. Your offer to help is—helpful. I don’t know what else to say.” (Group laughter.)

TW: “Try repeating word for word.”

M: “OK, Start again. (In role—loud deep commanding voice.): You’re not ready to be on your own. You don’t need all the stress. Come stay with me.”

Alt-Ego J: (In a loud, deep parody of “M”) “You say I’m not ready to stay on my own!! I should come stay with you!” (Lots of laughter.)

TW: “ Yeah, OK! Very good! Now, do you want to try it the way you actually might do it?”

(After a bit of tangential conversation during which another Group member coached J and rehearsed with her on the side, individually.)

TW: “ OK. Let’ gather together and rehearse it as a Group. ”

M: “I know you’ll be much happier at home.”

Alt-Ego J: “You’re trying to help me make it through with all the stress.”

M: “Now quit all this fooling around. Just make up your mind and come home with me. You can leave as soon as you sign out.”

Alt-Ego J: “I understand that you want me to come stay with you. I just have to think. I appreciate the offer and concern.”

Alt-Ego J practiced several different rounds. Another Group member played Alt-Ego J for a round, then Janet took over:

M: “Don’t be stubborn. You know that you’ll do better if you come home and stay with me.”

J: “I know that you want me to stay with you. It seems that I’m being stubborn. I really appreciate your offer to help though.”

M: “And...”

J: “You’re expecting me to come stay with you, but I have to work things out myself.”

M: “Well, shouldn’t you? You don’t need to go right back out and face all that trouble.”

J: “You’re trying really hard to help me.”

M: “Yes. And...”

J: “I want to put this decision on hold. I’m going to talk with Dr. G- about this.”

M: “Well, I think that you can decide right now.”

J: “No. I know I was really a mess when I got here, but I’m lots better now. I want to talk with the doctor and we can wait. I don’t think there’s anything else to say right now.“

M: “You can see him in his office. It would be easier for you if you come stay with me. You’ll be fine.“

J: “I know you’re concerned and I appreciate the help. I just have to make my decision with the doctor about leaving, so let’s end the conversation about this right here. There’s nothing else I can say.”

M: “Well, you can just discharge yourself right now. What do you mean there’s nothing else to do? Just do what I say and come home right now.”

J: “I know you think that it would be best for me to come to your house. I need to plan this carefully. Thanks, but I will talk with Dr. G-. There’s nothing else to say right now.”

M: “Just stop this nonsense and come home.”

J: “No more talk about this.”

At this point Janet is encouraged to repeat this response—including firm direction for her mother—with little variation and without further conversation. She is being helped to stand her ground with others to back her up. In a Group session this reply could be provocative in itself. Janet has had several sessions of Round 1 where she has had the opportunity to express her full anger and experience empathy and concern from the Group. Even then she may feel pressured to give in to her mother’s commands. She may become angry at the Group leader for suggesting this procedure. This often leads to Group discussion during a Time Out from Psychodrama. In this instance, other Group members praised Janet for her effort after the Psychodrama. Janet herself related that she began the Psychodrama with a feeling of fear, but she felt stronger as the role-play progressed. Although the interchange may continue for awhile longer, if the Hero continues in this same vein, the person portraying the Villain has soon expressed themselves fully and a potentially destructive interaction has been defused. It is difficult for the provocateur to keep up their momentum if Hero or Protagonist does not fight. Sometimes they will become enraged at the Group or the leader. We are allowing the angry Villain or Antagonist to express themselves and drain off some of their anger.

As it turned out, Janet initiated a discussion with her mother the next evening during Patient-Family Group. Her mother did not argue and agreed fairly easily that Janet should plan her discharge with her doctor and arrange appropriate supports. Janet was clear and straightforward with her presentation. It appeared that a new frame-of-reference in which their communication could take place had been established.

The Hero maintains an even, calm emotional stance. She does not admit wrong doing even if the Villain expects this. In the ideal interaction Hero encourages mother to feel warmth and concern. If she is able to experience this successful communication, it may help her to resolve some of her frustrations and anxiety, even fear, that leads her to be overcontrolling. Like Hero, we are all attempting to develop ourselves as therapeutic agents.

Often the outlook of the Hero before Psychodrama is that the Villain must understand and acknowledge his or her point of view. Afterward this outlook changes. The Hero takes responsibility for the interaction rather than blaming the Villain. In this manner Hero’s Freedom has grown. ⁹

While these samples are very simplified examples, they are ways of presenting Psychodrama to Group members who are inexperienced. With the actual participation of Group members, and some guidance with the process, Psychodramas become complex quite rapidly. The effectiveness of Psychodrama grows as members of the Group become better and better acquainted with one another and as understanding and experience with Psychodrama increases. In the early stages anger is expressed only with difficulty and is carried over into Round 2.

John Kluthe has conducted Psychodramas with high school students, primarily exploring parent-child relations. He relates that initially the students see this technique as a means of learning how to control their parents rather than learning how to improve the quality of interaction between themselves and parents. He observes that this indicates a contamination of Round 2 by anger and desire for power that has not fully been expressed. It takes a good deal of discussion of the background philosophy by the leader, relating increased Freedom with acceptance of responsibility. There is a great deal of student venting, especially in Round 1, as well as redirecting and repeating Psychodramatic scenes, before they start to work on Round 2 goals. Adolescence is a time of great experimentation with taking control of life and evaluation of the responsibility this entails, as is adulthood in droves! Psychodrama is one method of rehearsal. ¹⁰

A new participant in an experienced Psychodrama Group can be encouraged to work on too much, too fast. This sometimes has a boomerang effect similar to a person having their defenses exposed too rapidly. At the beginning of this chapter it was noted how new people attending an experienced Group have described it as “weird” or left almost speechless and refused to return after only observing. It is important that the leader take note of anyone who, not understanding or not being prepared for a new experience, may be put off or even harmed by participating. Sometimes new Group members have entered right in to a Psychodrama unprepared, expressing emotion that has been held in check and felt a rebound rush of guilt. Response like this can even follow an experience that initially feels exhilarating. If the leader and other Group members are sensitive and have developed a degree of empathy, they are able to help one another, and particularly a new member, integrate these newly conscious emotions. Although the Group philosophy presented in the previous chapter recognizes Guilt as a step toward Freedom, a new Group participant may not understand this connection. Experienced Group members discuss—and struggle with these concepts repeatedly—developing new insights and depths of awareness.

On the other hand, as Group members become more experienced and the Group more cohesive, the responsibility of leadership is taken over. The Group members become very creative and therapeutically effective in staging and method.

Certain other techniques or variations are sometimes useful. Examples that originated with Moreno included “Soliloquy”, the Protagonist playing both roles, and “Role Reversal”, when the Protagonist takes the part of the Antagonist, sometimes changing seats to play both roles. These procedures are helpful when the supporting Group members can not reproduce the tone of the Antagonist to the Protagonist's satisfaction. The Protagonist can demonstrate how the Antagonist communicates and the verbal interchange between them. This exercise is often cathartic in itself, helping Group to empathize with Protagonist and helping Protagonist to develop empathy with Antagonist.

Other variations include the ‘Hot-Seat’ techniques identified with Fritz Perls. He elaborated on the ‘Hot Seat’ to become one of the mainstays of Gestalt Therapy. In this method Protagonist talks to an empty chair then sits in this chair and speaks for the Antagonist. One person can develop a complex dialogue by changing chairs in this manner. Perls uses this technique to explore the various roles of dream content. A single person speaks for different objects or characters that appear in their own dream thereby developing the symbolic meanings and/or reincorperating these symbols. Perls also has players act out different parts of their personality that have been neglected or denied–often the source of troubling symptoms. (Cf. Gestalt Therapy Verbatim (171)).

Group members develop the most interesting variations and scenarios as they become experienced and get to know one another. Over several years the Group in which I participated developed an unnamed Round which preceded Round 1 that McAfee dubbed “Round 0” (Round Zero!). Round 0 seems to function as a warm-up round, in which the absurdity of the situation is enacted, usually cracking us all up into laughter. We have seen Greek chorus-like choirs of muses walking around the room singing the praises of love, while the poor Protagonist tries to explain how hard it is to ask a girl out for a date. (With a good deal of laughter and kidding.) In later rounds these same muses become ‘allies’ helping Protagonist become more comfortable communicating with women.

In another Psychodrama, the Group room was turned into a machine shop. While the Protagonist attempts to inquire about a job with the foreman (in this case the Antagonist), forklifts drive through the room, between the players, over the table, while forges roar and metal is hammered into shape, interrupting (a bit of understatement!) the conversation. The Protagonist, who is an experienced player, finally shouts down a whole industrial operation. Then Round 2 comes—the real challenge: presenting one’s excellencies and securing that job.

The staging of Psychodramas, while usually fun and sometimes very difficult for the Protagonist, shows a depth of understanding and communicates Empathy of the Group. This deeper understanding of communication issues must be developed by Group members for successful portrayals. The therapeutic quality of Meaning Attribution recognized by Lieberman, Yalom, and Miles is developed by Group members in the planning and execution of Psychodrama. We become aware of problems and develop solutions for others and ourselves. These experiences are intellectually and Emotionally Stimulating. While not always obvious, the fun as well as challenge is a type of Warmth and concern. Recognition of the need for structure and rules as well as discussion that includes ethical approaches to our lives and the lives of others, demonstrates Executive Function, often taken over by the Group.

In a Psychodrama that is somewhat reminiscent of the opening of this chapter, an applicant to a college is faced with a room full of bureaucratic secretaries whose interest in gossip is far greater than their interest in potential students. Once this hurdle is overcome, the applicant must face a gravely harried administrator. Although these situations sound rather gruesome on the surface, the empathetic fun of reenactment helps lighten the general awfulness. The Group members recognize their own situations in the Protagonist. Communication of this common experience is a major ingredient of Empathy. These players are experienced and Group members know each other pretty well so jokes and challenges are part of the scene. Humor often is the best medicine. It is only when a new member seems to be comfortable with a challenge that they would be pushed or thrown into an advanced Round Zero straight away. Usually new people watch for awhile with a great deal of interest or uncertainty, until they feel comfortable to venture into Psychodrama. Perhaps I have made it sound more of a venture than it really is. If a member of the Group is nervous, we can also help them break the ice, so to speak. Alter-ego can help ease unsure people into a Psychodrama.

After participation in Psychodramas where irrational bosses, unconcerned teachers, distracted receptionist, as well as angry policemen, judges, persecuting nuns, priests, and ministers who even speak for God, are portrayed and answered to, first in anger then with empathy or at least a degree of understanding, the next challenge is faced. {Even empathizing with God may be possible. Although it is not Psychodrama, an example of deep role playing is presented by Desmond Tutu. During an interview with Amy Goodman he describes how he feels God must feel at times. [... On the Week of His 75th Birthday... (www.democracynow.org)]}. We then go back to the source. Parents, the primal authorities, are portrayed and real-life situations from childhood, or even more recently, are reenacted. First, Protagonist tells them what he or she really wanted to say in those situations. Then, Second Round is practiced. This is what could have been said with an attitude of integration and strength. Once again, therapeutic work takes practice, usually it takes repeated practice.

If anger or rage is too difficult to work through, a recess round is sometimes called when hypnosis, desensitization, or redirection techniques similar to those more recently developed and taught by Beck in Cognitive Therapy (14), are practiced—changing inner responses and the direction of previously accepted but compulsive behavior. Psychodrama is then resumed and new healthier communication is practiced.

Psychodrama can also bring poorly understood issues into consciousness and clarify them by dramatizing them for us all to understand and work with. Humor and play, drama and ritual, have repeatedly been referred to by other therapists and students of human development and healing traditions. Erickson and Piaget, Lifton, Bateson and Haley, Mead and Cooley, Yalom, Rogers, Cousins, Freud, Jung, Konner, and Adler have all identified these processes as powerful sources of therapeutic and maturational activity. Psychodrama brings them all togethter in a very unique and interesting event.

Participation is often a ritual or ceremony of entrance to Group membership. “You’ve weathered exposing some of yourself and we’ve all become a part of your life. You’ve become part of ours. Welcome!”

NOTES Chapter Four

1 Whiteneck, Theodore K.: Role Playing, Sociodrama, and Simulation Games: Implemenatation for the Life Science Curriculum: Master of Science thesis, University of Southern California, 1972 (246).

2 The harshness of Sartre’s phenomonological description should not be taken as his final word. He has written a prelude to an approach to human choice sympathetic to our own purposes, describing in a later essay how “...people...accuse existentialism of being too gloomy... I wonder whether they are complaining about it, not for its pessimism, but for its optimism. Can it be that what really scares them is...that it leaves to man the possibility of choice?” [Essays in Existentialism (204:33)]. Relevant to our study of the cathartic effect of drama, he is a play-write as well as a philosopher and novelist who wrote much of Being and Nothingness while surviving in the French underground with his existential colleagues Simone de Beauvoir and Albert Camus, among others, during WWII. Rollo May also weighs in: “The fact that existential psychotherapy places emphasis on these tragic aspects of life does not at all imply it is pessimistic. Quite the contrary. The confronting of genuine tragedy is a highly cathartic experience psychically as Aristotle, and others throughout history have reminded us. Tragedy is inseparably connected to human being’s dignity and grandeur, and is the accomplishment, as illustrated in the dramas of Oedipus and Orestes and Hamlet and Macbeth, of the person’s moment of greatest insight” (148:34). William Ofman develops a counseling-psychotherapy approach for Humanistic-Existential perspective largely centered on Sartrian and allied philosophies: “...I am making a rather explicit statement about the nature of man. I am positing that the concept of intentionality-which-is-consciousness means that in addition to brute reality, man tends to invent meaning and that this is his very nature. Man is intentional: he is orientation and directness to the world. To confront...encounter...and thus, to impart meaning...is his task in life” [Affirmation and Reality: Fundamentals of Humanistic Existential Therapy and Counseling (165:33-34)].

3 David Rapaport writes in The Autonomy of the Ego: “The developing ego then integrates these structural apparatuses and re-represents their discharge-limiting and regulating function in the forms usually desribed as defenses...These defensive apparatuses come to our attention in the form of motivations of behavior, such as denial, avoidance, altruism, honesty, etc.” (186:254-255).

4 Gregory Bateson is one of the leaders of the research team that recognizes and establishes the importance of the Double-Bind for therapeutic work. He credits Jay Haley with naming this situation. Cf. Steps to an Ecology of Mind (13:202) and Watzlavick, Beavin, and Jackson: Pragmatics of Human Communication (238:8). Haley’s works include Strategies of Psychotherapy (88) and writings on patterns of family communication (88), as well as expositions and interviews with Milton H. Erickson, a master of multilevel hypnosis and therapy (89, 91). Erickson is a favorite of Wallace McAfee. Explanations and summaries of the Double-Bind are presented by various therapists in Berger, Milton M. ed., Beyond the Double Bind: Communication and Family Systems, Theories, and Techniques with Schizophrenics (18).

5 It is a fairly common discussion in Group (often heated) around the question of expression of anger outside Psychodrama. Especially hot are the issues of when and to whom expression of anger is appropriate. I would refer back to Wallace McAfee’s interview in the previous chapter for fuller discussion of this issue. McAfee takes the radical view that the person who is angry is allowing the other who is the object of this anger to control the interaction. In blunt, first person terms: “If you are angry at someone, you are allowing them to control you through your emotions. You are giving up your Freedom.” Group members including the present company, often become angry at this idea!

6 Aristotle’s view of catharsis in Poetics is also relevant to our therapeutic goals. The witnessing of drama, even tragedy, provides catharsis for the members of the audience. There is the traditional dramatic process of tension leading to crisis, followed by resolution. We have here a bit of foreshadowing of the final chapter of this study.

7 Bateson (13:206) and his co-workers, including Haley (88), Watzlawick, Beavin, Jackson (238:8), et al., identify the Double-Bind as a source of extreme confusion, often leading to mental illness. They study schizophrenia in particular. The Double-Bind is also implicated in a number of other psychological syndromes leaving the Protagonist confused and disheartened, and often dysfunctional. It may approximate a feeling of “Damned if you do. Damned if you don’t...and it’s your fault. You just want to blame me for all your issues. You know exactly what I’m talking about and what to do about it. You’re just trying to get me to take care of you and solve all your problems. So you sit there while the situation deteriorates, and you won’t let it go.” This may be spoken or, even more difficult, implied—a truly ‘crazy making’ experience. Haley also shows the presence of the Double-Bind in many therapeutic interactions including hypnosis, psychoanalytic transference, prescribing the symptom, and power-control issues involved in such admonitions as telling the client: “You know exactly what I’m talking about and what to do about it.... Good! Be yourself. Be natural and all else follows.” Of course it does. The client has succeeded. And so has the therapist! Cf. Strategies of Psychotherapy (76). Bateson and his coworkers Jackson, Haley, and Weakland identify the ingredients that produce a Double-Bind: 1) two or more Persons, 2) repeated experience, 3) a primary negative injunction, 4) a secondary injunction conflicting with the first on an abstract level, 5) a tertiary injunction preventing the victim from escaping, 6) the complete set of ingredients is no longer necessary when the victim has learned to perceive his or her universe within the Double-Bind perspective. In Berger, Milton M. ed., Beyond the Double Bind: Communication and Family Systems, Theories, and Techniques with Schizophrenics for a variety of perspectives and summaries (18:9-11).

8 This comment was inspired by my own experiences as student in classes that were supposed to operate as personal growth groups but were competitive at base, i. e., not everyone would pass the class—and you don’t even get your tuition back! Talk about a Double-Bind. Some teachers dealt with this in an up-front manner and the competition became an issue to work with therapeutically. In classes where these issues were not addressed openly, hostility often broke out between students and even between students and faculty. Rumors among students were that you had to sue the department or school to finally get your degree. Talk about a toxic crowd—posing as a group environment. At one point when the professor was meeting with the whole class, a student criticized his ideas. This resulted in the professor screaming (literally) at the student: “Get the fuck out of here! I don’t need this!” She got up and left (but returned the next week with no incident). Ideas that she was trying to get across got lost in the drama. It seemed to be a continuation of a previous conversation. Perhaps this was an undeclared Psychodrama. In L. A. at that time “Living Theatre” was popular as well as confrontational approaches to ‘therapy’ such as Synanon. I asked this fellow student about whether she was concerned about the professor’s outburst. She said she wasn’t. She commented that he just has trouble dealing with strong women and especially Jewish mother figures. (This is a paraphrase of an actual statement.) She was a middle-aged woman with a great deal of therapeutic experience as both a school counselor and, later, a social worker, as well as being a parent, now working on her Ph. D. The topic of the popularity (if this is the correct noun) of therapy with Jews—and especially their activism in the development of this discipline—had frequently come up in class discussions—the Prof also being Jewish—this usually discussed with a sense of pride and sometimes collegial humor. The student later had civil conversations with him in class. Anger in this and other instances continued for much of the semester. Its expression did not lead to any healthier level of interaction that I could identify, other than possibly entertainment. On the other hand, perhaps involvement in this type of event sensitizes students to aspects of the experience of being brainwashed—a topic in a Sociology of Education class that I was also taking—the experience of involuntary “psychotherapy” as may happen to patients who have been committed. Both of these last topics were issues discussed both professionally (hospital staff) and in class at that time. University students were often attracted to libertarian views, e. g. Thomas Szasz and sometimes R. D. Laing. Hospital staff concerns were for people whose behavior could cause danger to themselves or others. We often discussed Laing and Szasz—even attending a lecture by Laing as a group, but Dr. Szasz’s view of having a person arrested if a danger, even due to mental illness, seemed to us a inhumane, especially when many of our patients thanked us after recovery for helping them regain control of their lives. The issue seems to be whether a psychiatrist then a panel of psychiatrists should make a determination of whether a person is held and treated, or whether a judge should decide this sans treatment, often deferring to a psychiatrist in the end.

Sometimes senior graduate students were instructed to lead groups of more junior students in styles and techniques with which the senior students were not skilled or comfortable. Junior students often also had more therapeutic experience, like our Jewish mother above, than the senior students. Research studies were also conducted without the subjects (these same junior students) being adequately informed. All of these procedures may be in the fine old traditions of the academy, the behavioral sciences, and the initiation of grad students, but in the end there seems to be some grave ethical issues involved with a lack of responsibility for the often powerful effects of our “therapeutic” approaches. T-Group research shows similar issues when employees were encouraged to be open about their feelings toward their supervisors, but confidentiality was later violated with destructive results [Cf. Bradford, Gibb, & Benne, (22)]. My hunch is that the source of many group failures in the Stanford Encounter Group Research cited in Chapter 2 may have had related origins. Even if the groups were not presented as competitive, the general academic atmosphere would be present as a matter-of-course. Also an issue: while an instructor imparts information, it is the responsibility of the student to study and learn the subject. In my academic experience, some instructors were personable with students while others would not be bothered. (Notice how this theme has appeared and reappeared in the clinical and psychodrama chapters and probably several other places as well. This may be my own ax to grind.) In my understanding of counseling and psychotherapy, the therapist should maintain communication with the counselee to be aware of any deleterious effect that may develop. There are procedures that surface anxieties and other uncomfortable, sometimes disorienting experiences including past traumas (PTSDs) and crises experiences (Ch. 6). Becoming aware of Compulsions and conversion of these to Guilt with increased Freedom, as described in the previous chapter, may be accompanied by similar awarenesses. Granted, this is not always easy, but it is part of the “therapuetic relationship”, and follow-through and follow-up may even be presented, and necessarily agreed upon, as a “therapuetic contract” by some clinicians. This is one of the reasons therapists claim themselves as experts; although not all therapists agree, Fritz Perls, for example.(Cf. “The Gestalt Prayer” Cf. “Fritz Perls” entry Wikipedia.) for comment of therapeutic responsibility (171). He seems to function as a “stage therapist” like a “stage hypnotist” demonstrating to admiring workshop participants during his last years at Esalen. In spite of denials of concern at times in his presentations, at other points he seems to express helpful interest. This may be Perls’ Therapeutic Double-Bind. In the Clinical Chapter 2 above, there are indications in some of the encounter group narratives that follow-up, as would have been part of a therapy group or crisis intervention as described in Chapter 6, would identify participants who have negative results, concentrating on resolution to these issues.

9 During rewriting, after 30 years of experience, this account of transformation in relationships seems too breezy, easy, and just naïve. I would point out, however, that it does represent the model of Psychodrama technique and procedure accurately. The work and support that a couple or family needs, whose members may have severe symptoms and fairly entrenched habits, or what I termed in the previous chapter (following McAfee) “compulsions,” is greater than implied above. There are types of interactions that are so disturbed that other treatment approaches need to be undertaken before Round 2 can be successful. For example, a woman may be depressed or a child may develop disturbed behavior due to abusive relationships. The victims’ safety must be addressed before communication styles can be practiced. An alcoholic or addicted family member may have to address his or her chemical dependency before effective interpersonal counseling can begin. Sometimes what seems to begin as communications counseling uncovers these deeper, more entrenched issues. Intervention must come first. Family members, rather than the identified patient, may need help with developing an intervention. Functional family members may benefit more rapidly from therapeutic process. Role-playing and Psychodrama may help them deal with emotional reactions as well as rehearse methods of intervention. Although I have implied it, the importance of repeat practice of new communication styles should be emphasized. Sometime clinical vignettes highlight breakthroughs, but as with every new learning experience: reading, writing, music, art, dance, etc., these do not improve without this practice.

10 John Kluthe, Ph. D., personal communication.

III. APPLICATION

CHAPTER FIVE IS A CONCISE SUMMARY
AND SYNTHESIS OF THE COMPONENTS OF

GROUP TRANSFORMATION LEADING TO

THE DEVELOPMENT OF

THE CRISIS INTERVENTION WORKSHOP.

CHAPTER SIX IS A DESCRIPTION OF
THE CRISIS INTERVENTION WORKSHOP.

CHAPTER 5

CONVERGENCE AND SYNTHESIS

"We converge for the psychical and deploy for the physical.”

• R. Buckminster Fuller,
From a speech at Orange Coast College, 1976

As we gather together with other people, to meet and share ideas face to face, we are impinging a wealth of forces—psychical and physical—social trends, attitudes, outlooks, values, experiences, and abilities into a relatively small locus of time and space. The Group presents us with a type of crucible in which change and transformation take place. With so many ingredients and possible conditions many types of response are possible.

Although this study has been presented in an orderly fashion beginning with the Foundations of Group Transformation for both the Group as a whole and members as individuals, proceding to specific structures of interaction, conditions for healthy change, then philosophy, theory, and techniques for transformation, it is possible for our study to dissolve into chaos under the sheer weight of ideas and information. It is important that the reaction be mediated and not left to random events, arbitrary interactions of particles of composition. Indeed, the Group, at times, seems to have a dizzying effect of sensory overload for participants. Even experienced members sometimes express exasperation or even a mild feeling of terror when overwhelmed with the possibilities of transformation.

This is a description of a crisis.

In the midst of a Group discussion a member will unexpectently become angry or even burst into tears. It is time for Group members to stop, listen, and try to understand. Often there are deeper flows of emotion than those of which we are conscious. I would ask the person speaking about what they have not talked about but need to. The Group members may also be sensing issues or emotions coming to awareness. Sometimes the empathetic response is to recognize that there are feelings that are hard to experience and don’t seem to have any solution. This is an area for further discussion. I recognize the emotion and promise to return. Often special procedures or techniques are called for—sometimes by the leader but often by Group members. A number of these are described and discussed throughout this study.

Group members participate in many different manners, and the Group interaction undoubtedly has different meanings for each member. The chaos may also be interpreted as potential versatility. In the next chapter we will experience one highly pragmatic deployment of a small Group, focusing on this very sense of overload. This is the Application of this study, the training of competent Crisis Intervention counselors.

In this direction and purpose we can see the workings of McDougall’s five principle conditions for raising mental life. (Cf. Chapter 1 above.) In the Crisis Intervention Workshops, Group participants are Psychiatric Unit and Emergency Room staff who work together every day. While the relationship of Group structure to the family as described by Freud, Fromm, Mead, and Cooley may exist as unconscious trends, these Groups are Primary Groups; the members have close work relations even before Group formation. The reason, nature, and goals of the Group are clear, although the process may be surprising.

Groups composed of counselors from different backgrounds or institutions have common interest and a universe of discourse in their therapeutic approach that is the basis for Group Cohesiveness. Even when their individual training, techniques, and perspectives differ, there is a source of creative tension that brings us together as a Group: Universality based on individuation and personal development.

At least part of one session explicitly has to do with interactions between various departments and disciplines of a general hospital or if participants come from different organizations or fields, we develop a common institutional model and find that we all develop a common experience to base a “sociodrama” game from. In a short time the Group develops a culture as well as an approach and methods that relate to successful Crisis Interventions research. Members play various roles including patients, interventionist, and Group leader.

Tillich’s ontological questions of being and nonbeing influence the structure of both the crisis that the patient experiences as well as the structure and process of the Group. These are the ultimate issues of survival and positive development of the personality. Adler’s social interest and Mead’s interpersonal development of choice, mind, and self are at the heart of the crisis process and the intervention approach. Becoming Crisis Intervention counselors involves us in the practice of these communicational qualities as the extension of the Curative Factors and Therapeutic Ingredients.

The patient in crisis is at the point of choice between Compulsion and Freedom, often experiencing overwhelming Guilt. This Guilt takes the form of confusion or extensive rigidity, both with a debilitating sense of anxiety. As a means of coping, this Guilt has become diffused into various symptoms. Focus on this Guilt may lead to pain too deep for the patient to process at this time. On the other hand, patients who use tight self-control to deal with crisis may feel they have lost this important quality. This loss has launched them into their crisis. They may feel themselves flooded with Guilt, even to the point of drowning. The counselor extends Forgiveness in the form his or her presence, embodying and communicating Curative Factors with the patient and in the style of the Therapeutic Ingredients. As counselors experience these in the Workshop, they may extend this experience to their patients.

The organization of the workshop gives rise to a group process outlined below:

Week 1: Theory of crisis.

Week 2: Role-playing à Experience of crisis.

Week 3: Discussion of crisis experience à Theory of intervention.

Week 4: Theory and techniques of intervention. Role-play intervention.

Week 5 & 6: Role-play and develop interventions.

The implicit group process may be described as follows:

Week 1: “Crisis” is defined. This is done in such a way that it is brought into investigation as a universal process and experience. The anchoring of crisis in development is approached through Sullivan’s descriptions of the development of the “Self System”. The relativity of Sullivan’s Self-System tells us that each person’s self is built on foundations laid down in early childhood. In crisis we re-experience developmental crises. As such each of us experiences a certain disorientation at a time of crisis; our self concepts are threatened. The difference, then, between a healthy resolution to life crisis and an unhealthy resolution is a major theme of this workshop. Erikson’s developmental stages help us to understand a structure to crisis. This session ends with a certain anticipation, an open gestalt.

Week 2: Although we could study the theories of crisis intervention at this time, the experiential nature of the workshop and role-playing would be wasted. We would substitute an intellectual exercise for real life. The crisis experience is brought to the Group. It becomes part of the process and is shared between the members in triad role-playing.

Weeks 3 & 4: Now that we know what a crisis is, through a role-play experience, we can figure out how to intervene. Group members become resources for interaction and information. In role-play and Psychodrama we develop therapeutic attitude and direction; we figure out where to go with intervention.

Weeks 5 & 6: We have all the theory that we need at this time. The last step is to figure out what we are doing and practice, so that when a crisis arises, we intervene almost reflexively with maximum effectiveness.

By the fourth week the workshop leader is done ‘leading’ and may be called on to structure a Psychodrama or role-play, act as a resource person, or encourage members to share experiences and knowledge with one another. Another important function of the leader may be to point out particularly relevant experiences or ideas brought up by members. In this way each individual’s experience and approach becomes part of the experience of all members. The Group develops interventions for each member and each member contributes to a common Group experience.

In McAfee’s description, a person is encouraged to become aware of his or her Guilt and Freedom. They become aware, seek, and are extended Forgiveness, which leads to a transforming life experience. The Group as a whole undergoes this process as each member does. Forgiveness, in this case, is the process of working towards a therapeutic experience for all Group members.

Lifton describes the healing process with the terms Confrontation, Reordering, and Renewal. In the workshop we experience crisis, experience intervention in the Group, and continue life with a new, deeper understanding of the crisis intervention process.

Finally, role-playing and Psychodrama are the basic acting through of the process, a form of continually evolving ritual that is both rehearsal and enhancement of life.

CHAPTER 6

THE CRISIS INTERVENTION WORKSHOP

“Decisions come in existential crises only.”

• Karl Jaspers Philosophy Vol. 3:100

As a staff member at the Neuropsychiatric Unit of Long Beach Memorial Medical Center, I had the opportunity to implement the theories and techniques discussed in the previous chapters. While organizing and conducting a series of workshops for other Psychiatric Unit and Emergency Room staff, I was able to explore and observe the effectiveness of small Group techniques, particularly role-playing and modified Psychodrama. These approaches were presented with a Group process and personal development orientation to teach perspectives and skills that are basic ingredients to effective Crisis Intervention.

I will describe some fundamental reorganization and extension of methods and theories previously discussed along with description of basic format and goals for these workshops. I begin with the theme of the workshops and the approach using role-playing, then a description of the workshops themselves, and, finally, discussion of the Group process that takes place during the workshops.

When patients are seen during a psychological crisis, they are involved in an event that may be compared to the First Round of Psychodrama. (Possibly an apt description of a Psychodrama is the attempt to precipitate or re-enact a crisis and carry it to its healthy resolution.) In our view of crisis we fundamentally disagree with psychologies that see adjustment as an ideal. Crisis is a goal, a necessary part of personal change, if it is resolved correctly. Carkhuff and Berenson write:

The only real psychotherapy takes place at the crisis point, most often with the focus initially on external crises for the client, but eventually crises involving both client and therapist, in and out of therapy. At the crisis point both client and therapist are stripped of all façade, which is indicated by what they do or do not do. This communication is the most intimate person-to-person communication that there can be. There are no rules for responding, no techniques, no rituals. The therapist simply has to “be” to experience the moment and stand the tests. The effective therapist responds most honestly from the deepest wells within him. His response reflects his recognition of the life or death urgency of the situation. He responds the way he lives his life and he chooses life in response. In his “being” and acting he discloses the meaning and efficacy of his approach to life.

Beyond Counseling and Therapy (30:147)

Patients seen in the Emergency Room in emotional or psychiatric crisis are at the point of change. They have, or their life situation has, effectively, brought to a head the same experiences that are developed to climax in the First Round of Psychodrama.

Psychodrama offers further insight into the crisis situation. If we turn the process of Psychodrama in on itself, we are given a solution: Round 2 is the effective intervention for the First Round. This is the basic premise and approach on which the Crisis Intervention Workshop is developed.

EVOLUTION OF THE CRISIS INTERVENTION WORKSHOP

The inspiration for the Crisis Intervention Workshop comes from two sources beyond my membership experience in the McAfees’ Group and my clinical supervision with Wallace McAfee. I established a Crisis Intervention Service as a liaison from the Neuropsychiatric Unit to the Emergency Room at Long Beach Memorial Medical Center. At this time, this was a newly developing mental health treatment specialty. I had seen a number of patients in this capacity, and from my previous experience in Psychodrama, I found that following a Round 2 method of responding was very effective for establishing communication with extremely emotionally upset or confused people.

When patients arrive at the Emergency Room and are in a high level of emotional turmoil, their main issues are often communicational, interpersonal, or related psychiatric problems. They are referred to Crisis Intervention after medical clearance. When confronted with the complexity of the hospital environment and red tape, they may be in a very difficult situation. Overwhelmed and frightened, it is not unusual for them to become defensive and angry.

After introducing myself and calmly explaining some basic procedural issues I listen and respond back, communicating my understanding of the facts and particularly the feelings that the patient seems to be experiencing in words and behavior. While establishing this communication, I attempt to maintain a non-alarmed tone of conversation, conveying an assumption: “We can work these issues out.” Often, repeatedly recognizing the confusion and/or upset that patients experience, verbalizing this understanding (empathizing), (“This is confusing and scary.” I take a dramatically deep breath then exhale slowly; nod my head and shrug my shoulders slightly; possibly hold their hand.), creating a calm accepting climate, they become more comfortable and organize their thoughts. A cathartic effect is achieved in this conversation, and patients begin to evaluate their situation and options with more clarity. Sometimes this catharsis comes with a temporary increase in agitation and a period of ‘draining off’ of this emotional energy. Radical therapists describe this procedure as “talking a person down”. Ruitenbeek [Going Crazy: the Radical Therapy of R. D. Laing and Others (197)] presents a number of clinical approaches to establishing therapeutic alliances with people in extremely disorganized, highly stressful mental states. At this time we also have an opportunity to evaluate how emotionally labile the crisis patient may be.

While this description is of an individual patient in crisis, it should be recognized that clients often present as couples or whole families. Often one person is identified as the presenting patient, but all parties: friends, family, and other referring persons, may be agitated and confused. For the sake of clarity and workshop practice, a single person will initially be presented as an example. In later sessions the complexities of family crises, as well as issues that sometimes develop with other interested parties, often persons who accompany or accommodate the patient’s arrival at the E. R. Jay Haley Problem Solving Therapy develops an initial treatment approach for families (90:Chapter One), an excellent introduction to a slightly different Crisis Intervention. These accompanying parties may include social support or legal services (police, sheriff deputies, rangers, EMTs, social service and case workers—even taxi cab drivers). Often discussion and problem solving will facilitate a return to the patient’s normal living situation with referral and possibly new level of support.

As the patient calms and begins problem solving procedures, I become a ‘resource person’—pointing out the different routes that can be taken, often reflecting the patient’s own ideas toward ‘next steps’. I supply additional information, as much as seems needed or is available.

The second source of inspiration leading to the development of the workshop is my day-to-day experience working on the staff of a milieu oriented psychiatric hospital unit. This is a very intense work environment in which staff members are involved at close interpersonal level with the patients. This psychiatric unit could be described as crisis oriented. The average stay for patients is two weeks and the goal for all but a few long-term patients is resolution and return to home and the community.

Often blocks in communication develop between patients and staff. When staff members or patients experience and communicate a perception of a deteriorating sense of interpersonal interaction, staff experiments with organizing a role-play or Psychodrama. These role-plays are often in staff Groups, with no patients present, but they also can be developed directly with patients in the daily Patients’ Group sessions. When a patient complains or in some way reacts to a communication problem, one approach by which we explore these issues in Group, is to develop and practice a clearer interaction by enacting a role-play. Disorganization of behavior or decompensation of thought processes is often an indication of unaddressed issues. Sometimes these issues are with staff or doctors, sometimes with other patients or family members. In a Group in which the focus is on improved relationships, other patients are also sources of help. Often fellow patients become aware of problems before the staff from their day-to-day interactions on the psychiatric unit. They are very perceptive during discussions formulating solutions. Role playing and Group communication can encourage this problem solving process.

When a staff member expresses a sense of bewilderment about approaches to what seems to be confused behavior, or when we staff feel that we are unable to interact therapeutically, we discuss and reproduce the issues in our conference sessions—playing the parts of patients and staff intervenor—following a format described in the previous chapter of Catharsis and Resolution. By role-playing these interactions and practicing new communications approaches, more congruent interactions are developed. (Sometimes the disorganization is ours.) With a clearer view, less encumbered with anger or frustration, and newly practiced interpersonal approaches, staff members are able to communicate with greater effectiveness and creativity.

With the realization that any staff member can be called on at any time to intervene in a crisis, I set about developing the workshop that I describe below. I have conducted the workshop about a dozen times (at the time of the initial writing of this study), usually six, two hour sessions in each series. During each of these rounds of workshops, I have tried different variations and approaches, with the result that, in my experience and opinion, as well as feedback that I have received from participants, the most effective format is presented below. I have also used similar themes teaching Master of Business or Public Administration students, combining social and political justice issues to the basic Crisis Intervention theme.

DESCRIPTION OF THE CRISIS INTERVENTION WORKSHOP

The workshop takes place on a weekly basis for six weeks. Many of the participants already know each other quite well, being work partners. Usually the workshop draws from two or more hospital departments such as Psychiatry and Emergency Room, so members of each department have worked with one another while they meet people from other departments anew. This allows cross-fertilization of ideas and approaches. Factors such as Group Cohesiveness are already developed. These workshops can also be the basis of institutional communications development. When participants do not know each other, I instruct them to introduce themselves to one another, sharing information about professional experience and orientation. If the number in the Group is fairly manageable, less than 10-12, a size to form a Group, I take time for members to introduce themselves, possibly having them form pairs, introduce each other, then have each of the pairs introduce the other member of the pair to the whole Group.

The first meeting is mostly didactic, with discussion about theories of Crisis Intervention. Before I present these, a description of the basic orientation of the theories is necessary.

Standard medical-psychiatric approaches to crisis have been largely of an objective nature. The patient and the crisis are viewed at a distance by the intervenor. An evaluation is made and certain ‘interventions’ are attempted after which results are evaluated. On the other hand theories and techniques of counseling and psychotherapy have developed toward an interpersonal approach. Sullivan (216, 217), Truax and Carkhuff (222), Carkhuff and Berenson (30), Erikson (60, 61, 62), and Rogers (190-195) are clinicians who exemplify this interpersonal outlook; interaction between the person in crisis and the counselor is the center. The quote by Carkhuff and Berenson, above, is an illustration of one particular approach to this orientation. Two poles, objective and interpersonal, represent a dilemma existing in the field of psychiatry today. In developing Group process the movement from the former objective approaches to the interpersonal is beneficial. This may later be followed by a return to the objective. This balance in perspective helps give the crisis counselor understanding and a ‘handle’ on the crisis situation. Even as the intervenor empathizes with the patient’s directionlessness and confusion, while establishing communication, he or she retains a sense of grounding in the Crisis Intervention process developed and presented in this workshop.

The first theories that I will present are classic crisis intervention theories. The greatest amount of work done in the field centers around them. Gerald Caplan, who could be considered a patriarch ¹ of crisis intervention has given a definition of ‘crisis’ that is quoted many places in the literature:

A crisis is provoked when a person faces an obstacle to important life goals that is, for the time being, insurmountable through the utilization of customary methods of problem solving. A period of disorganization ensues, a period of upset, during which many abortive attempts at solution are made. Eventually some type of adaptation is achieved which may or may not be in the best interest of that person or his fellows.

Principles of Preventive Psychiatry (27:40)

Aguilera and Messick summarize this definition in their classic text:

A person in crisis is at a turning point. He faces a problem that he cannot readily solve by using coping mechanisms that have worked for him before. As a result, his tension and anxiety increases, and he is less able to find a solution. A person in this situation feels helpless—he is caught in a state of great emotional upset and feels unable to take action on his own to solve the problem.

Crisis Intervention: Theory and Methodology (3:1)

It can be seen that there is a spiraling effect in a crisis that I summarize with the following diagram:

A problem exists. Solutions are attempted. These fail resulting in a sense of confusion and anxiety. As these distressing emotions increase, often a person’s self-esteem is eroded adding to an already insurmountable problem. Commonly, manifest behavior associated with this spiral is agitation, a spiral upward and outward, or depression, a spiral downward and inward. Caplan, as well as Aguilera and Messick, emphasize that a crisis is not, in and of itself, undesirable. It rather reflects a change in a person’s life that may have beneficial aspects if handled correctly. The beneficial effects are what Crisis Intervention is meant to enhance.

The place or the role of the interventionist is to strike into or intervene in the spiral. A commonly used objective approach by medical doctors is the administration of a drug. A doctor may inject the patient with a minor tranquilizer such as Valium, blocking the experience of anxiety and allowing the patient to view the initial problem with a more detached perspective. This is an effective, relatively rapid way of calming a patient overwhelmed with emotion. In most crisis situations, however, and even after calming with a medical intervention, it is vitally important to identify the source and dynamics of a patient’s reaction and also help them calm themselves. Interaction between therapist and patient, even during emotional upheaval, is important. This is an evaluative, diagnostic issue, measuring the intensity of the crisis. These issues are topics to be discussed in the latter sessions of the workshop. We have gotten a bit ahead of ourselves as sometimes happens in a crisis.

In extreme cases, when the state of crisis has existed for years, the spiral may have become such an integral part of a person’s life and usual behavior that the crisis becomes a chronic condition and is generally diagnosed as a type of such severe mental disorder that more complex treatments may be indicated. This may temporarily be treated by hospitalization and procedures such as shattering the ingrained circular thinking with a more extreme method such as major tranquilizers or even electroshock treatment which is still used for a few people who suffer from depression untreatable by other methods. For the crisis at its inception this would be like cracking a walnut with a thermonuclear device.

As one of the main goals of the Workshop, we want to develop ourselves as intervention. We want to enter into the crisis and use our own personalities, experience, and training, in interactions with the patient, to participate with and lead out of this spiral.

One technique that includes both physiological treatment and interpersonal orientation is physical movement. Walking a person in crisis has been used for untold ages to decrease anxiety. Just as the increase in metabolic rate may be used to sober up an intoxicated person, it may also be effective at decreasing agitation or animating a depressed person. While walking, the intervenor is also establishing contact with the patient at a time when verbalization may not be possible. Gardener ² describes how he was able to dissolve an anxiety block for a thirteen-year-old boy that had interfered with his ability to read. Instead of having him sit at a constricting school desk, Dr. Gardener had the boy walk as he read. Initially the therapist put his arm around the boy’s shoulder in a supportive manner while walking. At times I have paced patients up and down the hospital halls for as long as an hour before they have been able to speak. Walking also may be a method of draining off agitation, hyperactivity, or, on the other hand, as described above, encouraging organization and talking. Counting out steps, one-by-one, sometimes in a deep, quiet but authoritative voice, can focus a patient’s attention on thought process and physical experience, both of which may initially be fairly chaotic or, in depression, hazy and vague—weighty.

In the next stage of the Workshop, I review several concepts and communicational processes developed by Harry Stack Sullivan. Sullivan’s Interpersonal Psychiatry does not speak directly to Crisis Intervention but offers a view that encompasses three areas of understanding that are important for our Crisis Interventionist perspective. He describes a developmental view of communication. He provides an understanding of anxiety states. Finally, his perspective is interpersonal. Through Sullivan we come to understand how the patient in crisis is interacting with us, as well as what a crisis is in light of that interaction. ³ Sullivan places the genesis of anxiety states in the interaction between the infant and the protective person:

Thus anxiety is called out by emotional disturbances of certain types in the significant person—that is, the person with whom the infant is doing something. A classical instance is disturbance of feeding; but all the performances of the infant are equally vulnerable to being arrested or impeded, in direct chronological and otherwise specific relationship to the emotional disturbance of the significant other person. I cannot tell you what anxiety feels like to the infant, but I can make an inference which I believe has a very high probability of accuracy—that there is no difference between anxiety and fear so far as the vague mental state of the infant is concerned.

I have reason to suppose, then, that a fear-like state can be induced in an infant under two circumstances: one is by the rather violent disturbance of his zones of contact with circumambient reality; the other by certain types of emotional disturbance in the mothering one. From the latter grows the whole exceedingly important structure of anxiety, and performance that can be understood only by reference to the concept of anxiety.

The Interpersonal Theory of Psychiatry (217:9)

Here we see that anxiety, which in later life fuels the crises of the people we meet in the emergency room or on the psychiatric floor, is an experience we have all had to deal with to some degree, at some time in our lives, although probably in not so overwhelming an amount. In its extreme form Sullivan describes this feeling as the uncanny. The uncanny is best likened to a feeling of being overwhelmed, victimized by tremendous malevolence. The “Self-System” of a person is undermined by the uncanny, a sense of of identity as Not-Me, to be discussed below, is this experience.

The uncanny may also appear in traces, e. g. as we walk on a dark, deserted street at night and feel a presence following us, but turn to find no one there. In crisis the feeling may be continually of such dread possibly magnified.

A mirror experience imbued with a positive emotional valance is that of awe. We may feel this in an enormous architectural structure such as a cathedral or listening to a symphony or highly amplified concert; possibly we experience awe in nature as on the edge of the sea or the Grand Canyon. The overwhelming sense of awe, if felt to be benevolent, may be the basis of mystical or religious experience. (217:10) ⁴ Freud begins Civilization and Its Discontents discussing the “Oceanic” experience, as named by his friend Romaine Roland which Freud denies ever having but assumes others have. He develops a picture of deeper psychological source and meaning which I will acknowledge, but leave, as it would take this discussion into very complex areas in a different direction.

As the infant matures, this anxiety is woven into his or her personality and relationships with others, even while the very sense of others and perception of oneself, as an individual, develops. Sullivan describes three developmental complexities of experience relating to the infant’s symbolization of self and communication with the outside world, particularly other people: the prototaxic mode of experience, the parataxic mode of experience, and the syntaxic mode of experience. The infant grows through these three process levels towards adulthood. Sullivan calls the earliest level the prototaxic mode of experience:

The prototaxic mode, which seems to be the rough basis of memory, is the crudest—shall I say—the simplest, the earliest, and possibly the most abundant mode of experience. Sentience, in the experimental sense, presumably related to much of what I mean by the prototaxic mode. The prototaxic, at least in the very early months of life, may be regarded as the discrete series of momentary states of the sensitive organism, with special reference to the zones of interaction with the environment. By the term sensitive, I attempt to bring into your conception all those channels for being aware of significant events—from the tactile organs in, say, my buttocks, which are apprising me that this is a chair and I have sat on it about long enough, to all sorts of internunciatory sensitivities which have been developed in meeting my needs in the process of living. It is as if everything that is sensitive and centrally represented were an indefinite, but very greatly abundant, luminous switchboard; and the pattern of light which would show on the switchboard in any discrete experience of the basic prototaxic experience itself, if you follow me. The hint may suggest to you that I presume from the beginning until the end of life we undergo a succession of discrete patterns of the momentary state of the organism, which implies not that other organisms are impinging on it, but certainly that the events of other organisms are moving toward or actually effecting a change in this momentary state.

The Interpersonal Theory of Psychiatry (217:29) ⁵

Mullahy, a student and commentator of Sullivan summarizes:

According to Sullivan’s hypothesis all that an infant “knows” are momentary states, the distinction of before and after being a later acquirement. The infant vaguely “prehends” earlier and later states without realizing any serial connection between them. He has no ego in any distinctive sense because the self has not yet developed. For such reasons, he has no awareness of himself as an entity seperate from the rest of the world. In other words, his felt experience is all of a piece, undifferentiated, without definite limits. It is as if experience is “cosmic.” This mode of experience is often marked in certain schizophrenic states.

Oedipus, Myth and Complex (160:86-87)

Mullahy describes Sullivan’s concepts of the other two modes of experience. In addition to the prototaxic mode there follows the parataxic mode and the syntaxic mode. The parataxic mode includes the first rough efforts to understand the relationship of self to others leading to ego development. The parataxic is followed by the syntaxic mode which relates to language acquisition. Mullahy describes the parataxic mode:

Gradually the infant learns to make discrimination between himself and the rest of the world. As Sullivan puts it, he no longer reaches out to touch the moon. In other words he gradually learns to make elementary differentiations in his experience.

The parataxic mode of organizing experience occurs mainly through visual and auditory channels. Dreams are often examples of this mode of experiencing. But it occurs a good deal of the time in waking life. In other words we do not—and cannot—always organize our experience into a logically connected, related totality, in which the various elements are compared, contrasted, and ordered in a precise fashion. Ordinarily we do not indulge in careful ratiocination as we dress in the morning, proceed to work, and so on. It is not necessary and in any case there is not enough time...

...the child gradually learns the “consensually validated” meaning of language—in the widest sense of language. The meanings have been acquired from group activities, interpersonal activities, social experience. Consensually validated symbol activity involves an appeal to principles which are accepted as true by the hearer. And when this happens, the youngster has acquired or learned the syntaxic mode of experience.

Oedipus, Myth and Complex (160:286-291)

As the young child develops in the parataxic mode of experience, he or she begins to incorporate information received from others with his or her personal experience of feeling with what becomes known as identity. A reflective view is constructed called by Sullivan “The Self-System.” The Self-System functions, in part, to promote the type of relations with others that increases states of euphoria and decreases anxiety (217:164-168). Robert Jay Lifton writes: “In Sullivan’s case, with a concept of a ‘self-system,’ which, whatever early conflict it may contain, enables the organism to move in a ‘basic direction (that) is forward.’” [The Protean Self (138:26)].

The Self-System is composed of three parts: The Good-Me; the Bad-Me; and the Not-Me. The Good-Me is the term describing the sense of ourselves that we feel during interactions with others that bring comfort. The Bad-Me, conversely, is associated with the experience of discomfort. The Not-Me is a nebulous part of ourselves that we do not recognize to be ourselves. The Not-Me may include a sense of disorientation, dissociation, or vertigo—very uncomfortable—a state-of-consciousness to avoid! The Not-Me—or the world and ourselves from the perspective of Not-Me—may be entered in dreams, trance, what Sullivan describes as “brown-studies”, or in unusual instances such as crises. ⁶ As the name implies, we do not recognize this state of mind to be us. A person experiencing themselves as Not-Me may actually be more unsettled and more uncomfortable than when identifying with the Bad-Me. A sense of the uncanny, discussed above, may be a great part of this experience (217:161-164). [There is even evidence that The Bad-Me may be a preference to the The Not-Me, sometimes suppressed by substituting delinquent, criminal, and pathologically compulsive behavior (80, 92), which of course, includes alcohol and substance abuse]. An extreme, almost panic feeling, a variation of this type of discomforting primal emotion portrayed so intensely by many existentialist writers including Kierkegaard, Dostoevsky, Kafka, Sartre, Camus, and Colin Wison’s subjects of his Outsider series is often described as Dread, . Both William James and his father, Henry James, Sr., chronicle the sudden onset of a deep sense of despair and meaninglessness that is characteristic of this dread or uncanny [The Writings of William James (105)]. William also discusses an approach that he developed helping himself overcome this experience, presenting a multitude of extreme altered states of consciousness of many varied people. He details these in The Varieties of Religious Experience his Gifford Lectures (106), comparing what he considers “healthy minded” religious mental states with the “sick soul”. Possibly his entire career as the fountainhead of American psychology and major developer of the philosophy of Pragmatism may have been in response to these experiences. This is similar to Freud’s self cure psychoanalysis grew from with The Interpretation of Dreams and Psychopathology of Everyday Life. Jean-Paul Sartre has described “anguish” as a related experience—less intense or debilitating than dread or more extreme anxiety states. Anguish may be a prelude or an announcement to action, sometimes creative action—denial the source of bad faith (205:35-45).

It may be inferred that in a crisis situation we attempt to cope with the highest, most mature level of functioning that we have available. When our normal methods of coping are inadequate, the healthy person can usually reorganize his or her outlook and develop newer, creative methods for problem solving. With repeated failure, however, or shock too sudden or too great, we all may find ourselves in a regressive crisis experience. As our higher levels of resources are expended, the earlier successful lines of defense are attempted If these fail, we may continually be thrown into regression through the syntaxic mode of experience, and further back to experiencing others in a parataxic mode. (A corollary of this process is that crisis patients are often literally unable to speak or when they do, express a sense of alienation toward their environment and those around them.) At this point the foundations of the Self-System are laid bare. We are thrown into the experiences of the Not-Me and overwhelmed by anxiety in the form of the uncanny that seems to be a part of this stage of development. Different people have incorperated the uncanny, to a greater or lesser degree, as part of their Self-System or personality. All of us have some—and in milder variations it is important to our well being. As Erikson implies, cited in the following sections of this paper, in the correct instances, we need some sense of distrust and other developmental experiences that we usually find unsettling, in order to develop our abilities to do reality testing. It is when we are overwhelmed that we are in crisis. ⁷

With this in mind, crisis counselors may see that it is the strength of their own Self-System and the constancy that they give to interaction that works for both themselves and their patients. In the Workshop we will develop communication of this sense of stability to upset people. It is important to reiterate that the crisis counselors are able to relate to the patient to the extent that they, themselves, have resolved their own life crises or are actively working to solve them. Crisis counselors lend their experience of resolution to the patient.

We have now studied several different theories and descriptions of what a crisis consists. We have seen how crisis is an event in life that every person may face at sometime. We have postulated that it may be a chance for growth, not necessarily a detrimental experience. Now, I would offer an even more radical view of crisis. Not only is crisis a universal experience. It is a necessary experience for human development.

Erik Erikson identifies a series of eight stages of human development that he names “The Eight Ages of Man”. Each of these eight stages is marked by a definite developmental crisis. Each of us, growing up, must resolve the crisis of each stage at the age that is appropriate to continue our growth. Lifton, who studied with Erikson for many years, describes how “...in his hands, the concept of identity provided a newly liberating flexibility in self-definition... and an equivalent responsiveness to social currents. All the while he was managing the difficult psychological task of placing the ordinary person (and for that matter, the researcher) into the flow of the larger historical process” (138:26). I strongly recommend that the workshop members read especially, Chapter 7 of Erikson’s Childhood and Society (60) in which he describes his development of these “Ages” and especially examples of the manifest expression of each Age. Each of these stages is characterized by a pair of polarities which the individual must balance in their personality and develop a “favorable ratio” between these poles. Each stage has a “basic virtue” which has the potential to emerge with the properly arrived ratio. In the following table I have listed the names of the stages under the column named “AGE”. The second column named “RATIOS” is the name of the polarities, which may be a description of behavior, attitude, or experience of the developing person. This column describes the developmental crisis that is the focus of this study. The third column is the name of the “VIRTUES” describing personal qualities that are developed with the proper ratios.

THE EIGHT AGES OF MAN

AGE RATIOS VIRTUES

__________________________________________________________________

Oral Sensory...........Basic Trust vs. Mistrust...............Drive and Hope

(New Born)

Muscular Anal........Autonomy vs. Shame and Doubt..Self Control and Will Power

(Infancy)

Locomotor Genital..Initiative vs. Guilt.........................Direction and Purpose

(Toddler)

Latency....................Industry vs. Inferiority.................Method and Competence

Adolescence.............Identity vs. Role Confusion.........Devotion and Fidelity

Young Adulthood....Intimacy vs. Isolation...................Affiliation and Love

Adulthood................Generativity vs. Stagnation..........Production and Care

Maturity...................Ego Integrity vs. Despair..............Renunciation and

_____________________________________________Wisdom_______________

Erikson describes these Ages as epigenic stages meaning that they are built on the preceding stages. Like the concept of regression used with Sullivan’s work to understand and empathize with a person in a crisis situation, Erikson’s stages show that he or she experiences the crisis along lines of previously lived crises. If a previous stage has been resolved in an unfavorable ratio, a developmental crisis will re-emerge, re-enacting this conflict. Exploring the topic identified as the “Hazard” or precipitating event in the upcoming section presenting Aguilara & Mesick’s Crisis Intervention approach, along these developmental lines, develops a focus for our intervention. Although initially this unfavorable ratio is a vulnerability of the personality, if resolved correctly, resolution at each stage will include resolution of unfinished issues from previous stages. ⁸

During a crisis a person re-experiences previous crises and, thus, may have the opportunity to resolve earlier as well as present crises.

Finally, it is important to note the concept of ‘ratio.’ In an interview Erikson commented:

And, if you don’t mind me registering a gripe, when these stages are quoted, people often take away mistrust and doubt and shame and all of these not so nice, “negative” things and try to make an Eriksonian achievement scale out of it all, according to which in the first stage trust is “achieved.” Actually, a certain ratio of trust and mistrust in our basic social attitude is the critical factor. When we enter a situation we must be able to differentiate how much we can trust and how much we must mistrust, and I use mistrust in the sense of a readiness for danger and an anticipation of discomfort. This, too, is certainly a part of the animal’s instinctive equipment. We must learn it in terms of our cultural universe.

Dialogue with Erik Erikson (62:15)

We now have several definitions of ‘crisis’ and several theoretical notions of the experience of crisis. The topic of possible interventions has been presented and will be developed during the course of the workshop. We will discuss and practice some specific methods of intervention. I conclude the first workshop session by giving an assignment for Group members to develop (create) a crisis in which they can role-play. This may be an original idea but it may also be patterned on an actual incident or patient with whom they have worked.

In the second session we launch into Group interaction with an exercise that is challenging, controversial, and designed to involve everyone. It is also a good method to encourage the participants to introduce themselves to one another and start conversation.

I direct Group members to form sub-groups of three. Each sub-group is to practice an interview technique. One person plays the role of patient; one person is the counselor; one person acts as an objective observer. After about twenty minutes triad members change roles. After changing roles one more time, each person has played all roles. As an added challenge, I instruct Group members playing the role of counselor to attempt to encourage communication by making direct statements instead of asking questions. Role-counselors may instruct role-patients about what they should talk about, or they may listen and reflect facts or feelings that the role-patient is communicating. Role-counselors may also empathize with role-patients. This introduces the topic of communication for beneficial change that I present later in the workshop as a synopsis of research cited in Chapter 2 regarding types and qualities of therapeutic interaction. ⁹
The counselors are also instructed to refrain from giving advice to the patient. The observer should comment when the counselor asks questions or gives advice. The observer may also be a resource for the counselor if they get stuck. Because this often happens with such restricted rules of communication, the observer may suggest approaches to try.

These rules challenge and bring out several features of intervention. This exercise opens the players to the development of empathy between patients and counselors. The observer is also in a position to develop a more objective viewpoint of the interaction in a counseling session. In the usual crisis situation, the patient is typically at a disadvantage, or may at least feel at a disadvantage. This exercise subtly changes the balance in what Bateson describes as complementary and symmetrical communication. Either of these communicational types, in pure form, rigidifies interaction. Interchanging the two styles through feedback and reciprocity leads to communicational progress where both parties benefit. ¹⁰

The counselor experiences a sense of being at somewhat of a disadvantage. This may help promote empathy with the patient. To explain: hospital staff can be characterized as ‘professional helpers’. The most common method of helping by helpers, both professional and amateur, is to ask questions about the problem and, then, suggest solutions. We are all subject to the danger of asking similar questions to all patients and suggesting solutions that we would use if we were in a similar situation. In addition, both patients and counselors experience anxiety and discomfort during a crisis situation. As the crisis intervention relationship is established there is a natural tendency to come to resolution as rapidly as possible to allay this anxiety. In this haste we often take care of the most obvious issues but may miss or ignore more cogent problems that underlie and even generate the present crisis. Like valium, we may calm the emotions but do nothing about deeper causes of the crisis. Valium or similar anti-anxiety medication, may help the patient feel more comfortable. Suddenly there seem to be no issues. On the other hand, some discomfort or anxiety, if the focus of the interview, can help identify and clarify the issues to work on. Sullivan discusses the sudden emotional shifts that take place between interviewer and interviewee in The Psychiatric Interview (186:Ch. 6). He also recommends the perspective of the “participant observer”. In Psychodrama terminology the observer becomes a reflective alter-ego. The triad approach creates a reflective tension for the participants. They watch themselves talk with the role-play patient as they are being watched by the observer. ¹¹

This exercise is also an excellent method to reproduce and introduce the Group process. The triads are small enough and personal enough to enable people who may be shy in the whole Group to comfortably begin talking. In another type of class I broke training groups up into triads and assigned a different type of group work. As an example, I asked each triad member to find out what the other members think about specific topics such as job related issues of communication or how to deal with unfairness of a supervisor. At another time I introduced problem solving, much as I will discuss in the next few pages, then posed several problems, a different one to each group, and asked Group members to interview one another to discover each of their ideas for solutions. In both instances I assigned triad members to report back comprehensively to the Group as a whole.

Paradoxically, while the small groups of three are more comfortable, the role playing is difficult enough to generate a certain tension that motivates a lively, often confrontive, discussion, when the whole Group reforms. When we reassemble, everyone is ready to talk. The assignment with the triads has been difficult from two aspects. The members are somewhat self-conscious about their performances as both patients and counselors. The rule not to ask questions has made the mini-role-play doubly hard for the person playing the counselor. The counselors are somewhat disarmed of their habitual methods of helping patients. Often they express irritation toward the leader for this unusual approach. We have created a model crisis in which the Group can be moved to intervene. While similar exercises are commonly practiced in sensitivity training and group, individual, and family counselor training, people in allied professions often find them new and interesting. As well as anger, participant often find new interview approaches stimulating and interesting. I have been told by counselors that the triad counseling role-play helps them develop new perspectives on interviewing and patient interaction.

In the next section I reproduce the whole Group discussion that followed this exercise in one workshop. Important issues are discussed that will be emphasized afterward:

Max (Irritated.): “Well, that was hard! I don’t see what the point of not asking questions is about.”

Ted: “That was hard. I’d tried it before in role-play and thought it added an interesting dimension to the interview, an added challenge. I noticed most of the Group struggling not to ask questions. Tell me what you experience.”

Jerry: “I rely on questions. Yeah, at least every other sentence I wanted to ask a question. I never noticed how often I use questions.”

Max: “Well, I found it very frustrating. There wasn’t much that I could say.”

Ted: “So when you couldn’t ask questions, you didn’t know what to do next. Talk a little about that.”

Max: “Yeah! How are we supposed to help patients if we can’t find out what’s causing their problems?”

Pam: “I thought that there was quite a bit that I could find out without even talking to the patient. Norrie (who role-played the patient for Pam) was looking at the ground. She wouldn’t talk, or just mumbled. I knew that she was depressed and probably frightened. I just told her how she appeared to me and told her to tell me about herself—then waited.”

Ted: “Give us an example of what you said to her, Pam.”

Pam: “I told her: ‘You look frightened.’ And when she responded: ‘Uh-Huh.’ I told her she could take her time. I would like to hear about why she was brought to the Emergency Room by her husband. I was just describing the reality of the situation to her and what I knew about it. I had read the admitting notes.”

Norrie: “When I started playing depressed, I was going to try to make as little sense as I could. Just grunt or something.” (Group laughter.) But, when you (to Pam) said that, I got angry. But I tried not to show it.”

Pam: “Then you said something like, ‘I don’t want to be here.’ I could really empathize. I mean, if I was here against my will, whether I was depressed or not, I'd be pissed off.”

Ted: “You were trying to get right to the core of the crisis; part of it was that she was here against her will.”

Max: “ But I still think you have to question the patient to find out what’s causing the crisis in order to solve it.”

Ted: “I think that sometimes that’s true. But first I think that it’s important to establish a relationship with the patient and evaluate their situation as accurately as possible before we offer solutions. Sometimes slowdown. Let the relationship develop.”

Jean: “That reminds me of what Dr. D___ said at the Suicide Prevention Workshop I went to last month. People often attempt suicide because they have gone to everyone they can think of and asked them what to do. Everyone tells them how to solve their problems without really finding out what they’ve tried or how they feel which might be horrible. Telling them what to do just loads up the issues. It just makes them feel worse and beyond hope. They’ve tried all they can think of and they don’t know what to do. If they knew what to do, they would do it! It’s a vicious circle. Or at least that’s how they feel. Often they feel so hopeless that talking to someone else just makes it worse.

“Dr. D____ talked about making the problem clear. He gave us the idea that if the problem is completely understood, the solution is obvious and the patient sees it. It’s not just something we give them. They might not always like it, but it’s right there. Dr. D_____ worked on ways that we could use to clarify what the patient says to us. Even write it out. Make lists or pictures or diagrams or something. Show them to the patient and have them revise them until they feel that all their issues are out there on the table. We can help them work them out later, once we all know what’s happening.

“Sometimes you have to sit with them a few minutes. I just say: ‘I understand that it doesn’t look like there’s anything you can do. We’ll work on that but let’s just be quiet for a minute and start fresh.’ Sometimes they get angry or start to cry, but if you sit quietly with them a few minutes or tell them you understand, let their emotions clear, they calm down and can think clearer. If they still are suicidal you still may have to admit them.

“I tried this with patients on the unit. When they are first admitted and I do the admission I do a whole problem-solving interview. When I first started working in psych, I felt no one would listen to my great advice. Now I have a sort of a script I can use. It organizes me and helps organize the new patient. They’re often pretty disorganized or, at best, they’re distracted, when they first arrive. I let them tell me about themselves and I tell them what they told me.”

Ted: “That’s a good example of what I’m trying to show. When you’re talking to the patient and asking for this information, you’re establishing communication with them. Even if their answers aren’t clear, by talking to them you’re greasing the wheels of the interview, so to speak. Can I use your report in future workshops?”

Jean: “Sure.” (Laughing.) “As long as you credit me as a proper reference.” (I probably could have summarized Jean’s comments and used them for an entire lesson!)

Ted: “The suicide issue is very important. It’s a topic that I want to focus on in future sessions, but right now I want to stay with your interviews and what happened.”

(Pause)

Max: “I see what you’re saying about finding out what’s wrong before telling patients what to do. Questions are more natural to me, though.”

Ted: “Yeah. I didn’t mean that this is the only method of interviewing. We get so used to asking questions and looking for specific answers, that doing other things allows the emotional issues to surface rather than just the logical. I think that we are trying to lend our own sense of comfort to the patient and we have to be comfortable. If we’re frustrated or angry or rushed, like Jean said, the patient’s going to pick that up and the interview is more difficult. Next week I want to present and try some other methods of intervention.

“Fred, Linda, Sarah, you had a lively group there. Tell us what happened.” (The discussion then moves to others who had mostly been listening.)

This discussion, which followed the triad-mini-group exercise, brings to the front several points about both crisis intervention and Group process. Due to time factors and the number of patients that the staff works with, there is a tendency to rush interviews. Instead of lending comfort to the patient, we can, inadvertently, lend our own feelings of being rushed to find out what is wrong and solve it. This does not necessarily help the process go faster, but it can result in more superficial solutions than are required. The Group discussion often centers on feelings of frustration, especially in working conditions, which interfere with the staff members doing an optimal job.

This particular Group discussion moved toward understanding more rapidly than usual as several members had had previous experiences with similar modes of interview. For this reason, I prefer that the Group composition be eclectic and balanced, made up of members with a variety of, as well as levels of experience. Members who are newer to the field are often more challenging, with more questions. They bring up issues and express feelings that more experienced Group members have gotten used to and are somewhat desensitized to. At the same time, the more experienced members speak from their expertise.

In other Workshop groups, several of the topics touched on here become themes of entire group discussion. Examples of these themes include staff frustration, empathy, more specific ways of communicating with patients, and, particularly, extremely disturbed patients including suicidal and potentially assaultive dangerous patients. Although Jean presented one perspective toward patients who are suicidal, there are other empathetic responses to patients that are dangerous to themselves or others. Not only do they feel alienated toward those with whom they communicate, but also experience an overwhelming amount of emotional pain and existential dread—the uncanny that was described earlier. They may also experience rage and tendency to violence. These issues will be discussed in the upcoming topic of Crisis Intervention: assessment and problem solving.

As leader, I take the role somewhat analogous to how I would work with a crisis patient. In other words, I have certain knowledge about the field that I may impart when the time comes, but participants must develop their own style and approach. With this in mind, I try to encourage Group members to talk about their own preferences in technique and help solve one another’s difficulties as a Group. I hold back with discussion of method and facilitate members sharing of their counseling approaches. I sometimes only comment empathetically and allow Group discussion to develop on its own. Then, in the next session, Group process becomes a demonstration of problem-solving.

Often, we end this session with more questions raised than solved. The example of Group discussion presented above appears to have more resolution than usual with a fairly long exposition by Jean of a procedure that she had recently learned in another workshop. I present this Group discussion to show an example of solutions coming from the Group members. While this seems to answer or resolve the Group problem raised, this may be somewhat of an illusion. Frustration that Max was communicating may not have been answered but rather suppressed by the rest of us expressing a Group consensus, a ‘more knowing’ attitude. As such we may have stopped inquiry too soon. A very fruitful discussion could have developed around Max’s feelings about this exercise. I could speak directly about them or empathize and allow him to develop his own description, especially if he was very talkative, which he was. Other Group members possibly feel similar to Max about this mini-triad-role-play and may take the que to express themselves. (There is the strong possibly that these angry feeling may be directed toward the leader.) Pam and Norrie’s role-play could also develop into exploration and discussion of crisis intervention interaction from the Group as a whole. There will be more on this theme in the next Workshop session when several approaches to problem solving will be presented. These processes give direction to the crisis once it has been explored. ¹³

PROBLEM SOLVING

While establishing communication is the corpus of the Crisis Intervention process, Problem Solving is the spine. During the past 5 centuries, individuals and groups of individuals have developed organized methods of problem solving, becoming the basic structural techniques of our scientific–technological culture. We can summarize these methods of understanding and coping with the uncertainties, change, and confusion of our own society and lives.

The roots of problem solving are in the Scientific Method delineated by Galileo and Bacon at the beginning of the 17th century. ¹⁴ The Scientific Method provides approaches for the counselor, once communication has been established with the person in crisis. In the next workshop description of the Scientific Method is presented and developed for Crisis Intervention procedures, followed by Aguilera and Messick’s more elaborate and specific Crisis Intervention problem solving approach.

The five steps of the scientific method and problem solving are presented in the next Workshop session:

1• Presentation of the Problem : The crisis is defined as clearly as possible. Sometimes, when understanding of the crisis is truly clear, the solution obviously follows.

2• Collection of Data : There may be two steps to collecting data. First, all information regarding the sources of the problem(s) should be determined. Then, information leading to possible solutions is collected and/or developed. In a Group this may be handled in a brainstorming session. With individuals, any possible solutions or partial solutions are collected. These should be considered even if they seem improbable or farfetched. Ideas are collected without judgment or evaluation. Relatives or friends who accompany crisis patients are sources of information and ideas about both etiology of the crisis and potential solutions. Records of previous crisis experience or relevant treatment records are reviewed. New ideas often develop that have not previously been taken account of. Trends develop that have not been recognized. It is not unusual that in this step new information comes to light and, consequently, The Problem is redefined—sometimes even new directions are indicated including involvement of new people and authorities. (A common example may be that what initially appears as a psychiatric issue has neurological or other medical symptoms the source of which must be addressed first, for example drug or alcohol intoxication or detox, as well as brain damage, tumor, or stroke. )

3• Hypothesis: The da

TRANSFORMATION IN THE GROUP

CONTENTS

ACKNOWLEDGMENTS

CHAPTER 4