Professional Documents
Culture Documents
Anecdotal evidence suggests that aer most patients have completed a successful treatment they
tend to remember two kinds of nodal events they believe changed them. One concerns the key
interpretations that rearranged their intrapsychic landscape. e other concerns special moments
of authentic person to person connection with the therapist that altered the relationship with him
or her and thereby the patient’s sense of self. (p. 904)
J. SCOTT RUTAN
WALTER N. STONE
JOSEPH J. SHAY
Acknowledgments
Title Page
Copyright Page
Preface
Acknowledgments
6. Forming a Group
7. Patient Selection
8. Patient Preparation and the Group Agreements
References
Author Index
Subject Index
We allow our ignorance to prevail upon us and make us think we can survive alone,
alone in patches, alone in groups, alone in races, even alone in genders.
—MAYA ANGELOU
ese four postulates are, of course, a most summary attempt to distill the
essence of Freud’s theories.
Do we psychotherapists see patients like Anna O or Emma von N in our
offices today? Probably not, unless we work in highly contained ethnic
communities where the role of nuclear family, extended family,
neighborhood, and church still hold sway. When these patients do appear,
they oen come to our colleagues in neurology or internal medicine. at
the types of psychopathology present in our society are different from those
observed by Freud suggests a powerful correlation between society and
mental illness.
Freud not only observed the patients of his day, he observed them within
the framework of that society. People in the Victorian era had a conviction
that “structure” could harness the very forces of nature. is belief in the
ultimate dependability of matter led to unprecedented productivity, wealth,
and hegemony over peoples of a more “primitive” nature around the world.
It is little wonder that Freud began to hypothesize about the “parts” that
make up personality—his theory fit comfortably with the science of the era.
In the intervening years, more modern psychodynamic theories began to
refer not so much to faulty parts as to dysfunctional relationships and
dissatisfying ways of living. Modern concepts of pathology are cast less
about mismatched or improperly fitting parts than about disrupted
developmental processes. However, in the current atmosphere, there is a
press to return to a more Victorian approach—of understanding our
patients as “broken,” suffering from a specific and discrete illness for which
there is, presumably, a specific and discrete treatment. (We are not referring
here to the significant advances in theory brought by the internal family
systems model [Schwartz, 1995], which emphasizes the struggle for
hegemony of the various parts of the personality.)
Whereas current psychodynamic theorists chart the evolution of
personality through social systems, Freud viewed the ego as essentially the
product of intrapsychic conflict. ough individual personality was
understood to be affected by interactions with significant others (especially
the mother), it was nonetheless not seen as predominantly formed in those
interactions. Rather, personality was understood to be the result of a
thoroughly inward process. e ego was conceptualized as a rational,
unemotional arbiter between the instinctual urges common to all people
and the acceptable mores of the particular society in which they lived. e
superego was “the alien it which tyrannizes the ego” (Binstock, 1979, p. 56).
Freud should not be criticized for this focus, given the genius required to
hypothesize as much as he did about human development. Rather, we
should simply understand that he did not have time or opportunity to
expand all his observations to their logical conclusions, though he began
this quest in Civilization and Its Discontents (1930/1961). e expansion of
his observations was le to later authors, who elaborated on the impact of
human interactions and developed theories about personality resulting from
interpersonal interactions. e apex of this trend is seen in modern theories
of object relations and self psychology, where the need for human
relationship is understood to be common to all people and fundamental to
the forming of personality.
If personality is formed in, through, and by relationships, then a
therapeutic modality that uses the interactions of networks of individuals
should be capable of altering disturbed or disturbing personalities.
In modern culture, the traditional sources of identity and continuity are
waning or gone. It is as if the Victorian and modern eras are opposites along
many important axes. Mainstays of the community and identity, such as the
extended (or even nuclear) family, the neighborhood, religious institutions,
and the ethnic group are all diminishing in stability and dependability. e
rate of change is now so accelerated that each generation would seem to
have its own culture. For example, mass media, including the growing
influence of the Internet, penetrates the nuclear family while mass
transportation explodes it, and those central places that once gave
individuals a sense of themselves are changing dramatically.
ere was a dependability about the future in Victorian times. If a goal
could not be attained in an individual’s lifetime, there was always the
reasonable expectation that it might be attained in the lifetime of his or her
children or grandchildren. is is not so today. Changes in technology are
exponential, occurring at a faster rate than at any time in history. If that
were not enough, technology has contributed even more lethal weapons of
mass destruction, and there is little in human history to inspire confidence
that at some point this awesome capacity will not be used. e value of
working for and investing in the future has been diminished, and most
modern individuals “live for today.” In recent years, fears about the
shakiness of the historically trustworthy safety net of Medicare and Social
Security may have added to this focus. If Victorian culture provided stability
at the cost of choices, in modern culture individuals are confronted with a
bewildering array of choices (Brown, 2002). Along with choices come
ambiguity and uncertainty. If Victorian culture provided secure but
restrictive relationships at the price of internal conflict, modern society
underestimates the importance of maintaining and sustaining relationships.
MODERN PSYCHOPATHOLOGY
It’s time to fundamentally rethink mental illness. . . . Psychiatric research today promises to
produce a true science of the brain. . . . Mental disorders are brain disorders. . . . What is emerging
today is a picture of mental illness as the result of a pathophysiological chain from genes to cells to
distributive systems within the brain, based on a patient’s unique genetic variation. . . . With a true
science of mental illness—from genes, to cells, to brain circuits, to behavior—psychiatrists will be
able to better predict who is likely to develop a mental disorder and to intervene earlier. Once that
happens, we will be in a different world.
e perspective from which we write this book does not reject this idea for
we, too, believe that neuroscience has a great deal to offer in understanding
the substrate of psychological distress and psychiatric illness. Even if we
agree, though, that the brain and the body are involved in essentially
everything, we do not believe that every visit to a therapist or a group
therapist is for a “mental disorder” or “mental illness,” even if the “disorder”
is described in some version of the DSM. Our focus on psychopathology
and psychological well-being is much broader and is directed not only
toward the reduction of suffering that attends a biologically based illness but
also to improving the ability of individuals to engage in healthier and more
gratifying interactions when they have been unable to do so.
In this context, we maintain that the ability to enter into cooperative,
loving, interdependent relationships has always been a sign of psychological
maturity and health. is is particularly so today. Indeed, one quick but
accurate indicator of mental health is the degree to which individuals allow
themselves to know how important others are to them. Conversely, feeling
excluded is not only an emotionally painful experience, it can have
neurobiological consequences. Ijzerman and Saddlemeyer (2012) report:
A number of research groups, including labs in Canada, Poland and our own in the Netherlands,
have reported that having the memory of being socially excluded—or just feeling “different” from
others in a room—is enough to change our perception of the environment around us. Such
feelings can prime individuals to sense, for example, that a room in which they’re standing is
significantly colder than it is. (p. 12)
Given the changes that have occurred in the world since Freud’s time, it is
quite understandable that the stereotypical pathologies of today involve the
ability to effect, experience, and enjoy intimate and sustaining relationships.
Consequently, the psychopathologies that confront modern clinicians, many
of which have attachment issues at their core, are character disorders (such
as borderline and narcissistic personalities) and mood disorders (such as
depression and anxiety). ese conditions can be understood as relational
problems. e borderline patient is too aware of the importance of others,
whereas the narcissistic patient appears incapable of knowing how
important others are. Depression and anxiety can both be understood as
adaptive responses to the terrors of intimacy. Fairbairn (1952a) was among
the first to state that it is the relationship with the object (another), not the
gratification of an impulse or drive, that is the fundamental fact of human
existence. It is as though modern patients do not disable physical “parts” of
themselves, as did Freud’s patients, so much as they disable their
relationships (Kernberg, 1976) and cannot adequately relate to others
(Havens, 1996; Kohut, 1971).
GROUP THERAPY
Group therapy, by its very format, offers unique opportunities to experience and work on issues of
intimacy, individuation, and interdependence. In such groups the community is represented in the
treatment room. It is usually impossible for individuals to view themselves as existing alone and
affecting no one when in a group therapy situation over any significant period. (p. 612)
CHAPTER 2
Differences between the way individuals think, feel, and behave when
alone and when in groups have interested observers for many years. Gustav
LeBon, in 1895 (LeBon, 1895/1920), and William McDougall, in 1920, were
among the first to write about the impact of groups on the behaviors of
individuals. Sigmund Freud, F. H. Allport, Harry Stack Sullivan, Kurt Lewin,
Carl Rogers, Solomon Asch, and Philip Zimbardo are just a few of the well-
known authors who have contributed to this field of interest. If we are to
understand more fully the ways in which participation in groups is currently
thought to be curative, we must examine the history of group psychology.
e difficulty in writing about group theory stems partly from the
American culture, which privileges the individual. Most therapists come to
group work from experience in treating individuals, and initially they have
difficulty appreciating the contributions of the group setting. In group
psychotherapy both individual and group dynamics are at play and
intimately entwined. Keeping both perspectives in mind is not easy. We
believe that it is most useful for clinicians to think about group process first
and then consider individual dynamics. In this way the clinician can choose
an intervention that would be most helpful in moving the process forward,
whether directed to the individual or to the group. is strategy serves as a
reminder of the contribution of group dynamics to the psychotherapeutic
process.
We see, then, that the disappearance of the conscious personality, the predominance of the
unconscious personality, the turning by means of suggestion and contagion of feelings and ideas in
an identical direction, the tendency to immediately transform the suggested ideas into acts; these
we see are the principal characteristics of an individual forming part of a group. He is no longer
himself, but has become an automaton, who has ceased to be guided by his will. (1895/1920, p. 35)
show how organization of the group may, and generally does in large measure, counteract these
degrading tendencies; and how the better kinds of organization render group life the great
ennobling influence by aid of which alone man rises a little above the animals and may even aspire
to fellowship with the angels. (p. 28)
McDougall further stated that clear goals and purposes are essential to the
effectiveness of a group: “ere is . . . one condition that may raise the
behavior of a temporary and unorganized crowd to a higher plane, namely,
the presence of a clearly defined common purpose in the minds of all of its
members” (p. 67).
us two of the earliest authors on the impact of groups upon
individuals, working independently of one another, identified several
important phenomena: the power of groups to affect the behavior of
individuals; the presence of “contagion,” or the capacity of groups to evoke
feelings in each of the members; and the importance of organization, group
agreements, and goals.
Sigmund Freud (1921/1955) added a great deal more to this discussion.
Freud did not directly refer to the operations of small groups. Rather, his
observations concerned large groups such as armies and nations. Much later
Fritz Redl (1963) related Freud’s work to group psychotherapy. Freud was
intrigued by the effect of the group on the individual, and his study of group
dynamics was a step in his further conceptualization of the superego, which
had been thought of as the ego ideal. As he considered what constituted a
group, in contrast to a collection of people, he posited that group formation
necessitates having a sense of purpose (a goal) and the emergence of clear
leadership. In 1921, he wrote Group Psychology and the Analysis of the Ego,
perhaps most famous for the introduction of the concept of the superego.
Freud wrote that all psychology is essentially group psychology:
e contrast between individual psychology and social or group psychology, which at a first glance
may seem to be full of significance, loses a great deal of its sharpness when it is examined more
closely. . . . In the individual’s mental life someone else is invariably involved, as a model, as an
object, as a helper, as an opponent; and so from the very first individual psychology . . . is at the
same time social psychology as well. (1921/1955, p. 1)
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.