Group Psychotherapy in THOMAS
Informed by the Group Analytic Psychotherapy Approach to Therapy.
In June 2003, when I started working as a group analytic psychotherapist for THOMAS, I had a few quite different ideas about my work with our clients. I had thirty years of mental health experience, both in the NHS and the Independent Health Care. I have worked with substance and alcohol addictions in hospitals, in various in-patients units as well as in the community, having such patients usually in an ordinary psychotherapy groups or in individual therapy. However, it was a challenge to be asked to conduct a psychotherapy group which consisted purely of drug and alcohol addicts who, in the majority of cases, also had a history of repetitive imprisonment. I felt secure in my group analytic therapy knowledge and, in my naivety, I only partially appreciated how much more there was to discover and to learn. Throughout the years, I had to adjust my approach to fit in with the purposes of THOMAS work. Thus I have learned to connect with NA and AA philosophy on recovery and to apply it, when appropriate, to my group analytic model. I had to re-arrange some of my professional and personal attitudes without compromising the basic group analytic theory. I had to become more available to our clients as a person than I have been accustomed to in my other therapy groups. Most importantly, I have become acutely aware of how immensely vulnerable most of the newly recovering addicts are, such as when having to overcome the feelings of shame, low self-esteem, low confidence and their intense drive to self-sabotage.
So what are some essential ideas of group analytic psychotherapy? Its founder was Dr S.H. Foulkes who developed his ideas on the experience of his work as a psychiatrist/psychoanalyst with shell shocked soldiers in the Second World War. This experience strengthened his belief in how each individual is ‘determined by the world in which he lives, by the community, the group, of which he forms a part’. He noticed how soldiers in groups helped each other and how they improved together, at times acting as therapiststowards one another. He observed how various unhealthy symptoms disappeared when they could be talked about with others and how conscious and unconscious psychological defences were easier to give up when there was a mutual, good enough relationship among his patients and staff. Furthermore, he could see how the individual’s ‘outer world’ became internalised so that man’s internal world became a reflection of his whole world. He could clearly see how man, from his early life to the present, has been and is inseparable from his experiences of the surrounding world, in all its shapes and sizes. Foulkes continued to use his group analytic theory after the War, applying his ideas to clinical work with people in need of therapy and developing, by now well recognised, clinical training in group analytic therapy in Britain.
Considering the above, we could, therefore, say that the group analytic therapy mainly focuses on meaningful verbal communication with others. This statement may appear to be quite simple, yet it presents me with the major task. The purpose of the therapy is to increase self-knowledge and a sense of personal self, so that our clients would be able to reflect with honesty on their actions and behaviour, thus avoiding being the victims of their own destructive impulses in future. One of the tools for achieving this purpose is an honest and open communication in the therapy group.
The service users need to develop a trusting relationship with each other as well as with me and other members of staff. Specifically, in a therapy group, they need to feel safe enough in their relationships in the group to open up their internal world and allowing others, including myself as the therapist, to hear what they are feeling and thinking. Next task, as a consequence of this ‘opening up’, is to be able to face up to a possible emotional pain and to overcome it with the understanding, compassion and containment by others in the group. This experience could lead to personal growth and a permanent positive change in their character.
Sadly, the mutually trusting relationship, which is not always easy to find with people who are not addicts, is even more difficult to achieve with our clients. Quite a number of our lads have a personal history of failed dependency needs in their childhood and adolescence. They may have been through a variety of various abuse, difficult parenting, traumatic separations and bereavements; in some cases they were living and growing up in socially deprived conditions and institutionalised care. They have been let down by others too many times.
Where other adolescents would be trying to separate and to test their independence through rebelling against ordinary, everyday authority, the majority of our lads were trying and testing drugs and alcohol, perhaps also rebelling against authority but achieving a false, destructive independency and becoming, instead, dependent addicts. This false, destructive dependency inevitably spread, in lots of cases, into dependency on the prison system, on social security benefits and on using and abusing other people to satisfy and to maintain their dependency on various substances. They have never experienced enough of a healthy dependency on others which would allow them to grow into independent, socially well functioning and mature adults. Their dependency on various substances has been stronger than their dependency on healthy relationships with people.
For most of our clients, it is a frightening prospect when I ask them in my therapy groups to trust each other enough and to talk about their past as well as about their current personal experiences so that they can begin to develop a healthy dependency on others. Because my psychotherapy groups are based in the first stage of their treatment, the notion of dependency brings to their mind recent experiences with drugs/alcohol which, by coming to a rehabilitation programme, they have been trying to leave behind. They would rather ‘forget’ their experiences which prevented them from growing into healthy, mutually interdependent adults. They would rather believe that what counts is only the present and thus bypassing the past which formed them and determined their place in the world. I have to be, therefore, empathic with their fears yet not be seduced into going along with their defences. I have to hold onto my ability to think in the face of our clients’, at times strong, anger, negativity and hostility.
Through their stay in the programme, the members are divided into two psychotherapy groups, which meet twice weekly for one hour and fifteen minutes long sessions. There are 9 places in each group and the members belong to the same group from the beginning to the end of their 6 months long stay. Because of the importance of the stability of the external setting, the group is held always in the same room. I do not bring a topic to talk about; topics usually emerge out of the material which clients themselves bring in. The themes could be hidden, at times suppressed and not easily reachable. I see it as my task and, eventually, as the task of more experienced clients, to help the group to bring the hidden material into open communication.
As a therapist, I have to be more active and gratifying than I would be if I were treating non-addicted patients. Inevitably, any upsets in the house have ‘ripples’ which extend to the therapy group. Thus inside the sessions we work very often with conflicts between residents as well as between residents and staff. Sometimes these conflicts are difficult to resolve and the setting at large has to take over and continue with work which my therapy group could not move further with. It is of outmost importance that we, as the staff, work together and thus provide good enough ‘parenting’. The actual THOMAS community setting at large has to provide further holding and containment. I hope I have managed to give the readers some idea about how psychotherapy groups in THOMAS work. In conclusion, I would like to say heartfelt thank you to all my past and current clients who have contributed generously to my knowledge and understanding of their journey through addiction to finding their road to recovery.
Dascha Boronat - Group Analytic Psychotherapist