Group Analytic Art Therapy

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Group Analytic Art Therapy

of related interest The Changing Shape of Art Therapy New Developments in Theory and Practice

Edited by Andrea Gilroy and Gerry McNeilly ISBN 1 85302 939 4

A Practical Art Therapy Susan I. Buchalter ISBN 1 84310 769 4

Creative Advances in Groupwork Edited by Anna Chesner and Herb Hahn ISBN 1 85302 953 X

The Essential Groupworker Teaching and Learning Creative Groupwork

Mark Doel and Catherine Sawdon ISBN 1 85302 823 1

Music Therapy and Group Work Sound Company Edited by Alison Davies and Eleanor Richards Foreword by Marina Jenkyns ISBN 1 84310 036 3

Groups in Music Strategies from Music Therapy

Mercédès Pavlicevic ISBN 1 84310 081 9

Group Analytic Art Therapy Gerry McNeilly Foreword by Malcolm Pines

Jessica Kingsley Publishers London and Philadelphia

Words on p.153 from ‘Help me to believe’ by Paul Brady. Copyright © 2005. Music and lyrics by Paul Brady. Sandyford songs, administered by Ten Ten Tunes (ASCAP) and Hornall Brothers Music Ltd. All rights reserved. Used by permission. Words on p.161 from ‘Song of being a child’ by Van Morrison and Peter Handke. Music by Van Morrison. © Copyright control (50%) /Universal Music Publishing Limited (50%). Used by permission. Excerpts on p.208 and pp.211–2 from McLaughlin, M. (1999). Reproduced with permission. First published in 2006 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Gerry McNeilly 2006 Foreword copyright © Malcolm Pines 2006 Cover illustration: Valerie Armstrong Illustrations on pp.170, 174, 182, 193, 198, 215: Patrick McAlister The right of Gerry McNeilly to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1T 4LP. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Library of Congress Cataloging in Publication Data McNeilly, Gerry, 1951Group analytic art therapy / Gerry McNeilly ; foreword by Malcolm Pines. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-84310-301-1 (pbk. : alk. paper) ISBN-10: 1-84310-301-X (pbk. : alk. paper) 1. Art therapy. 2. Group psychotherapy. I. Title. [DNLM: 1. Art Therapy--methods. 2. Psychotherapy, Group --methods. WM 450.5.A8 M4778g 2005] RC489.A7M3556 2005 616.89'1656--dc22 2005019372 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN-13: 978 1 84310 301 1 ISBN-10: 1 84310 301 X ISBN pdf eBook: 1 84642 457 7 Printed and bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear

To my mother, Annie, who struggled against great odds in her lifetime

Acknowledgements I want to acknowledge the following people who were part of my professional development: Bruce Males, who first introduced me to art therapy; Agusta Neff, Risa Brown and Margaret Riley at Foyle Hospital, Derry; my art therapy teachers, John Evans, Felicity Weir and Peter Wey, and my fellow art therapy students from 1975 to 1976. I am especially indebted to Janie Stott who was with me in my first years as an art therapist. In group analysis: Jeff Roberts, who first sparked the interest; Judy Barford and Jean D’Arcy for our early work in the therapeutic community; Drs Malcolm Pines (who also kindly agreed to write the foreword), the late Robin Skynner, Meg Sharpe and Vivienne Cohen; Patrick McGrath, who struggled alongside me in our training together, for his continued friendship and support; Patrick McAlister, my lifelong friend, whom I persuaded to sketch the drawings in this book, based on my descriptions of art work; Beau O’Donnell, for the early years; and Kay Bird, who was always a good critic. Jonathon Wood played a part in working as my co-therapist for a period. Part Two of the book would not have emerged without the influence of Dr Ruy Carvalho and the Portuguese Art Therapy Society. If I brought together all of these people in a group, I wonder what would happen. Finally thanks to Sara Taylor, for typing the manuscript and her helpful administration, and Rachael Warner, for her research input, not forgetting my sister Patricia, brother Peter and cousin Bernadette. A final note of thanks goes to Val Armstrong for painting the cover illustration based on an original idea of mine.

Contents Foreword by Malcolm Pines

Part One: The Origins

9

11

1

How I started

13

2

Early formulations and developments

24

3

Practical developments

40

4

The group as a whole

49

5

The individual in the group: transference constellations

68

6

Transitions

91

Part Two: The Portuguese papers – new developments

103

7

Introduction: literature review and developments since 1990 105

8

That which binds together can also pull apart: new theory and technique

122

Openings

153

10

Cross-fertilization

176

11

The matrix, the pattern and the fullness of emptiness

201

Final remarks

217

9

REFERENCES

218

SUBJECT INDEX

223

AUTHOR INDEX

229

Foreword

I agreed to write a foreword before I read this book. Reading the text has been illuminating, for McNeilly has shed new light on the depths of the group analytic enterprise. Hidden dimensions are revealed by the use of binocular apparatus provided by group analytic art therapy. McNeilly takes the reader on a journey from his Northern Ireland childhood, through musicianship, art therapy training and therapeutic community membership, and finally to his group analytic apprenticeship. The apprentice is now a master. The reader will find a good exposition of the theory of group analysis, spotlighted with vivid phrases: resonance and intuition dualled with dynamic silence and wisdom; complexity and simplicity; the ‘simple’ interpretation is built on the grasp of theoretical complexity. McNeilly adds to our understanding of Foulkes’ concept of resonance and, when he acknowledges the value of improvisation in formulating and delivering interpretations, he develops the principles and methods enunciated by Foulkes himself: that interpretations are given in an unfinished form that invites group members to take them over to elaborate for themselves. The art therapy experience has shown McNeilly the pivotal points of each session that potentially bind or drive apart the latent opposing forces. The group analyst occupies a pivotal position, has the ability and task to affect the group dynamics, the focus constantly moving from polar positions. In preparing this foreword, I have studied this text carefully, finding much of value with which to comprehend the intricacies of our group analytic enterprise. Of those intricacies, McNeilly writes: Paradoxically, psychotherapy is both a complex and a simple therapy. Existing theory ranges between the complex and the simple, more often the former. I am drawn to finding simple structures of understanding and intervention within the therapeutic frame. I believe that this is possible only if there is a firm grounding in more complex theory. The simple psychotherapeutic interpretation draws upon historical 9

10

GROUP ANALYTIC ART THERAPY

roots of theoretical complexity and the appliance of direct and subtle presentations.

I warmly commend this book to art therapists and group analysts alike. This is a rich, readable text that will stimulate thought and enable us to see more clearly the simple in the complex and the complex in the simple. Malcolm Pines, group analyst and psychoanalyst, founder member of the Institute of Group Analysis and editor of the International Library of Group Analysis

Part One

The Origins

Chapter 1

How I started

‘I come before you to stand behind you to tell you something I know nothing about.’ This was a saying that my father used when I was a child, but I never knew whether he made it up. I trust that this book will act in a similar way. It is before you, and as my work is complete I stand behind you. In telling you something, there are times when I have felt I know nothing, but I hope that what I offer is enough to describe group analytic art therapy in its theory and practice. I am sure that I am not alone, as most therapists will oscillate between knowing and not knowing. Some of my earliest memories revolve around groups. During my childhood, these groupings were the gangs I belonged to in which I became either the ringleader or the clown. On reflection, I can see I was happiest when I adopted archetypal roles, although I was ignorant of this at the time. When my schoolfriends called me professor, this was not in respect of my intellectual abilities but because I wore glasses. In those early days, our street was our playground; the neighbouring streets belonged to other gangs, whom we either joined forces with or fought against. The shed at the back of our family house was often the meeting point for the ‘Harryville Gang’, with varying shades of innocent fun and mischief being brewed and set in motion. These group experiences allowed me to play out my exhibitionism and enthusiasm. Other activities such as the boxing club and the army cadet force were strong group experiences. In my early to mid-teens, on Sunday nights, groups of between 100 and 200 teenagers would embark on mystery walks into the surrounding countryside. Each week, a small core, of whom I was one, would make the decision for the mass regarding our destination. There was a struggle, because the person who made the decision always had to have a surprise card up their sleeve to make the trip worthwhile. This could have been anything from hide-and-seek in the local haunted house or a boys-and-girls chase. We would set up the chase in such a way that those who had romantic or sexual 13

14


ambitions had good chances of success. We used to call the trips ‘pants’, but I never did remember why – possibly because they filled us with expectation to begin with and exhaustion once it was finished. Being a young teenager in the 1960s, and with an increasing interest in music, I was soon rocking and rolling with the excitement of the many new musical groups that emerged. By my seventeenth birthday, I had mastered four scales on my saxophone and become a musician. Much earlier, between the ages of seven and ten years, I recall going into public houses with my father and drawing portraits of the old men in there. I made what I felt was a fortune at the time and all the lemonade I could consume. In trying to view these early experiences from a group analytic perspective, I think that such strong group experiences had a containing capacity that helped me deal with my own childhood experiences. My artistic and musical strivings were, in part, a creation from, and reaction against, these early experiences. Many of the happy memories I have from my childhood were in relation to different groups. There was also an awareness that even though the pictures of my memory are placed in group settings, I still needed time to be on my own. At such times, I was seen to be rather odd, especially if I didn’t talk to anyone for a day or two. It is with these two aspects in mind that I will explore the balance of tensions between the individual and the group. I recall with fondness my training in art therapy in St Albans, England. As this was my first step into the world of academia and art combined, I was unaware of what would develop over the next 30 years. Although I was unconscious of it, the question of myself as an individual with the images I produced in my artwork and the ‘group as a whole’ were beginning to formulate. In this context, the large group was that of my fellow students and the college staff. The art therapy training course went some way towards looking at group dynamics, but this was confined mainly to experiential verbal groups, apart from one art group. With the other experiential art therapy groups, little or no attention was placed on the group processes. I will focus upon two aspects of those groups that I believe set me on course for working with groups and that ultimately contributed to my own group analytic approach. These two points were based on my experiences in these groups, which were led by two originators and renowned art therapists in England – a man and a woman leading different groups. Although much is owed to each of them, my own experiences left me with many doubts and questions. I recall sessions with

HOW I STARTED

15

the male group leader when it was as if he wasn’t there. The value in this approach was that I had the freedom to tap into parts of myself that previously had not been opened. I remember him walking around the room; when he approached me to talk with me about my work, I recall only short comments such as ‘That’s interesting’. I don’t recollect any conversation; I was often inquisitive about what he said to others. This technique could be seen as non-intrusive, but somehow I felt something was missing. There was an isolation and preciousness about it all. The artwork was seen to be the most important component, and verbal communication with the whole group was absent. The second illustrative point was to be seen in the female group leader’s art group. This was a better group for communication, but this communication was primarily channelled through her. In this setting, I found a freedom for expression of pictorial image. The leader had a gentle, non-intrusive manner. As far as I recall – difficult after 30 years – she structured her sessions by introducing themes. The strongest memory I have of one of these sessions was that I portrayed a dream and spoke about it. After putting it into words I recall a look of blankness (I assumed fear and disapproval) on her face, and then she walked away. I felt that I had been asked for something, and in responding I was left with an impression that it was too much for her to handle. The truth of my impression is irrelevant but both these group leaders with their valued techniques and qualities left me feeling that they had missed something. My impression is that such forefathers in art therapy established themselves primarily with a structure that I believe was founded on uncertainty. The uncertainty is in how they pioneered into a Victorian attitude to mental illness and handicap. I would hypothesize that a degree of suspicion may have existed in the creation of a therapy that focused on the power of the individual’s intrapsychic/interpersonal struggles in the production of the image through the art therapeutic process. Less attention was given to the spoken word and group communication in the early art therapeutic settings, as far as I know. Historically speaking, it appeared that some art therapists acted as go-betweens for the patient and psychiatrist. In these early days, and for some art therapists today, there was an elevation of the image through excessive interpretation from a psychiatric perspective. I now turn to the birth of my views on groups, as derived from my own positive reactions to the group of art therapy students that I belonged to. Approximately half of the students lived on the same campus; this community

16


had the effect of bringing together the vibrant energy that was an intricate part of our group. There were many culinary, musical and creative activities in the groups. Then there were two major issues that brought us even closer. The first was in the winter of 1975, when one of our fellow students died suddenly in our midst. The second was the extremely hot summer of 1976, when our group seemed elated. These two points clarify the power of life and death forces in close proximity and their effect upon the same group. Although such memories have idealistic or exaggerated qualities, I feel that my art therapy student days were the first rewarding group experiences in art and learning. These group developments led me then, almost by fate, into work in a therapeutic community. In developing my style, technique and theories, I had the new-found power of being an art therapist. I swung from the omnipotent to the omniscient position, where I felt I understood the world with access to a cure. With my later group analytic training, I came to realize just how much power exists in groups. I became less engrossed in gratifying my own desires and gradually recognized that I didn’t have a monopoly on power; therefore, it wasn’t mine to give. Assumptions are often made about giving more power to the patient, rather than assisting people to locate their own power. My theoretical formulations and clinical methodology first began taking shape within the confines of the psychotherapeutic community and then moved on to experiential groups with student art therapists and allied professionals. With this variety of settings, it became clearer over a period of 15 years that there were many universal processes within all the groups that I conducted. During that time, my work in individual art therapy and psychotherapy also took form. I hope to show in Chapter 10 that there is much to be learned and cross-fertilized between individuals and groups. My work as an art therapist has been enhanced greatly by my group analytic training; likewise, my verbal group analytic work has been enriched by the added dimension of image-making in the group. As this book is primarily about group art therapy, I have used sparingly examples and theoretical exploration of my individual art therapy work. However, as Foulkesian group analysis sets the individual in the centre of attention within the group process, attention will be given to the individual within that context. It is with some regret that I chose to write this book at a time when I am not practising primarily as an art therapist. Having held the position of director of a therapeutic centre along with further senior psychotherapy

HOW I STARTED

17

positions, I do not have an abundance of pictures to reproduce in photographic form for a book. When one works for many years in art therapy the shelves of the art room become laden with clients’ pictures and the good intentions of the art therapist to take snapshots for the elusive book that is always in the pipeline. When reality strikes, there are no pictures – only vague memories and written accounts. It would be impossible to trace the many people with whom I have worked, whether as patients, clients or students, in the groups I have conducted. Any use I make of my experiences as I reproduce them here are statements about my views with theoretical implications. I have endeavoured to express myself in such a way as to safeguard the anonymity of those people I have known. These group experiences, although portrayed in a formalized way, have been very personal to me. I thank those who have inadvertently taught me through accepting me as their therapist or teacher. Although I have been able to use some actual illustrations relating to imagery produced by patients, a substantial number of these are fictional. However, these fictions are based upon real events, people and groups. Now I want to move on to a more personal view of the history of British art therapy and where I have entered into this. I hope that art therapists, group analysts and psychotherapists will benefit from this book. It is not my intention that it becomes a book of dogmatic technique. The book is based upon my own thoughts about group processes and dynamics as I have experienced them along with group analysis as its principal theoretical modality.

Historical review The evolution of art therapy in the UK only came about in the relatively short period since 1942. I present here a brief account of its lifespan in order to focus at a later point on how my own theoretical and practical approach differs from how art therapy originated. The roots of art therapy are not as deep as those of psychoanalysis, the former tending to be surface-soil runners as a result of the many clinical fields of application they have moved into. I offer an early hypothesis (which I will address from different angles at different points throughout the book) that two types of art therapist have evolved: ·

those who place their methodology foremost on the image, viewed as a creative act with natural healing capacities

18

GROUP ANALYTIC ART THERAPY ·

those who place emphasis on the imagery as a psychological projection or external manifestation of inner disturbance and relationship problems.

I would venture that with the onset of training courses in art therapy, and since the early 1970s, art therapists who emphasize closer links between both of these positions are evolving. This moves the focus to a more integrated approach of the two. I do not intend to explore the causality of such splits within the brief of this chapter. As a result of my work and discussions with colleagues over the years, it would appear that some art therapists who have placed the emphasis on the art and symbolic side dismiss links with earlier psychoanalytic– psychotherapeutic models for fear of contamination, which is seen as debasing the whole creative/artistic life of the individual. On the other hand, the art therapist within the psychological model, with mixed alliances to early psychiatric–psychoanalytic origins, is perceived as explaining the imagery as ‘sick’ productions with access to the therapist’s interpretive techniques. In Britain today, I believe the trend is healthier, because the definition of art therapy is more encompassing. There is a greater acceptance of the dynamic forces between art and therapy. Returning to my analogy of art therapy being a set of surface-running roots, these have moved into hospitals, day centres, family centres, child guidance, prisons, schools, therapeutic communities, and many other clinics and institutions. The list of patients/clients with whom art therapy has been used is extensive. Although high praise is justified for the art therapy movement in Britain, I feel that the profession as a whole has suffered from a dilution of potentially exciting theoretical models, with a limitation upon new schools of thought emerging. In recent years, art therapists have given more consideration to a need to consolidate theory within their own specialized fields. Art-therapy books have tended to take the form of collected papers by various authors, for example Dalley (1984), as well as single authors, for example Waller (1993) and Schaverien (1999)). In earlier art-therapy papers, either there tended to be an adherence to the art side, with the study of symbolism and aesthetics, or the theory was presented as psychopathological images derived from case studies. Little was written about the intricacies inherent at the interface between the therapist and the patient/client. Transference and counter-transference were rare currency in print until the late 1970s. Between the late 1980s and today, the

HOW I STARTED

19

British art therapy literature has come more into its own, with various theoreticians and clinicians laying claim to particular schools of thought. I have purposely presented a simple snapshot of primarily individual art therapy history from the two positions cited: the art expression being linked to aesthetics, symbolism and art activity as a healing agent in itself, and the art expression that conveys inner turmoil and relationship difficulties. I have resisted focusing upon the range of theoreticians and practitioners who have been central in these developments, as it would unduly lengthen the introduction.

Institutional aspects At the beginning of the twentieth century, throughout the British Isles, large institutional buildings were erected to house mentally ill people. These large Victorian prison-like buildings were, on the whole, placed on the outskirts of major cities and towns. One of the purposes of this was to remove such people from society, but also the influence of nature was felt to have curative effects. These institutions could each accommodate over 1000 patients. Until the 1940s–50s, people with mental illness, mental handicap, autism, physical handicap and, at times, misdiagnosed mental impairment often were housed together. Some women were hospitalized for having illegitimate children. Not until the 1959 Mental Heath Act did different diagnoses begin to be considered to have their own criteria for treatment. It was into this renaissance of treatments for mental illness and mental handicap that art therapists emerged in the mid-1940s, including such pioneers as Adrianne Hill, Edward Adamson, Dianne Halliday and Rita Simon. In my early days as an art therapist (the mid-1970s), the art therapy jobs in hospitals were few and far between. Although there is now a greater expansion into many clinical settings, the market is still limited for art therapy positions. Within psychiatric hospitals, art therapy departments were often found in some rather strange locations, such as a disused laundry or bakery, a cellar, an abandoned ward or an old shed in a distant part of the hospital grounds. Susan Hogan addressed this: He [Michael Pope] described going on pilgrimages to the art therapy departments of many of the pioneers including Adamson, Weatherson, Glass and Lydiatt. He explained that as an impressionable young man, these figures assumed legendary status and there seemed something quite magical about the atmosphere and creativity in their art rooms.

20


Tucked away somewhere in the maze-like geography of the old psychiatric hospitals, their studios were congenial, cluttered and colourful havens in a world of clinical routines and barren wards. (Hogan 2001, p.199)

Was the distancing of the art therapy (‘remedial art’ was an old term) department a sign of its being placed in an ‘out of sight, out of mind’ position? Or was it that the power of art therapy was experienced as a threat? Were people ‘sent’ to art therapy to get them off the ward? Or were people ‘referred’ to the art therapist as part of treatment? Generally speaking, the art therapist today is in a much more secure position, both professionally and politically (art therapists are state registered). In the structural planning of new departments, hospitals, clinics, psychiatric wings of general hospitals and prisons, the art-therapy room may be seen in the architect’s plans. Likewise, in the creation of new, and modifications of old, therapeutic systems, the art-therapy medium is often at the forefront. The idea of a patient being ‘sent’ to art therapy is now a thing of the past, the old concept being that patients in psychiatric hospitals needed to be sent off the ward to occupy themselves. Within the concrete structure of the art room, a balance of tensions is evidenced within the structural setting and the therapeutic conditions. A simple example may be illustrated. In my very early groups, which were conducted in a small room with no sink, water was supplied in buckets before the beginning of a session. The imagery produced often reflected the smallness of the room, with strong boundary lines being drawn. People used less paint; a feeling of poverty and making ends meet was evident in the imagery and ‘acting out’ would happen. This acting out took the form of people not attending sessions, running out of the room, seeing little consequence in trying to create in a room that reflected their internal mess. In our second, larger art room, the group’s attitude to art therapy changed, and much of what had occurred in the small room disappeared, became modified, or was easier to contain and work with. In the second room, a new sink was installed along with a clay area and a kiln. There was more personal space and better equipment, and a more serious attitude emerged. Patients and staff were now placing importance on the therapeutic process, and there was more of an equilibrium between the structure and the processes within it. The therapeutic setting is, therefore, an intricate, conscious–unconscious play between structure and process.

HOW I STARTED

21

Some years ago, shortly after I trained as an art therapist, I was on a bus journey. In the seat in front of me, two schoolgirls of about 13 or 14 years of age were discussing what they wanted to do on leaving school. ‘I want to be an art therapist,’ said one. I smiled. She may now be reading this book. The route to my present position was never really planned until my group analytic training, which was an extension of my art therapy training. I left school at the age of 15, with no qualifications or ambitions, and started work in a factory on the following Monday, which lasted a week. From that point, everything seemed to happen by chance, but the group format in future decisions had its hold and was determined unconsciously.

Brief outline of this book I trust that for those people who are acquainted with group analysis, as devised by S. H. Foulkes, the more common aspects will not detract from my links with art therapy. It has been necessary for students and those new to the field to restate well-known group analytic theory as developed in Chapter 2, where I have attempted to create dialogue between accepted Foulkesian theory and group analytic art therapy. In Chapter 3, I present a historical development of group analytic art therapy as it originated within the context of the therapeutic community. I hope that such an exposition gives substance to the development of theory and practice. In Chapter 4, I move the focus on to the ‘group as a whole’, a term coined by Foulkes. Within this, I compare my earlier group theories and methods. I have also drawn from a number of my earlier publications to add further contrasts. Within this chapter, as with the others, I present clinical illustrations in order to give form to the theory. In Chapter 5, although I am moving the focus to the ‘individual in the group’, I examine transference constellations along with the place of interpretation. In contrast to individual art therapy, what should be understood from the beginning is that individual art-therapy settings cannot be transposed wholesale to the group situation. The ‘individual in the group’ is a complex matter. Working with an ‘individual in the group’ and making use of the group context is more elaborate than an individual (pair) psychotherapy arrangement. In my clinical considerations I have described the start of a new group as on a par with an individual starting in therapy, as well as looking at the individual perspective of a new person entering an existing group.

22


In the latter section of Part One, I describe how a more sophisticated transition emerged (Chapter 6) and in Chapter 10 of how cross-fertilization between group analysis and group analytic art therapy came about. Part Two is built upon new developments since 1996. I intend to show how my theory and method have become more refined over time. Chapter 7 is an exposition of the group art therapy literature to date. I have called Chapters 9–11 the ‘Portuguese papers’ because much of the newer material was initiated by my connections with colleagues in Portugal. Not only was there a new opening for me theoretically and professionally, but, as will be seen in Chapter 9, I attempt to open up further dialogue on one of group analysis’s key theoretical points – resonance – linking it, I think for the first time, to intuition and wisdom. This has allowed me to move more delicately into the areas of complexity, subtlety and simplicity. Chapter 8 extends well-held views in British art therapy into the ‘triangle’ significance. Here, I attempt to move previous perspectives into a new three-dimensional appreciation and integrate this more with group-analytic approaches. Much of this chapter also addresses the dimensions of duals, polarities and oppositional forces. Organic matters are our concern in Chapter 10, as I develop the ideas of cross-fertilization and grafting. Principally, this is about how such theoretical matter is shown in the relationship between art and verbal group settings. It also considers the interconnectedness between content, process and structural aspects of group analysis, although such areas are touched upon throughout the book. Within this chapter, I reconsider the ‘individual in the group as a whole’ as a single entity, thus grafting ideas previously separated. In Chapter 11, I turn my attention to another established group analytic concept: the matrix. In keeping with the Portuguese influence, I expand the concept of the pattern, as developed by Eduardo Cortesão, who studied with Foulkes and was a pioneer of group analysis in Portugal. I am surprised that others have not, as far as I am aware, written about the connection between the matrix and the pattern. However, Pines (1991) has written a fitting tribute to Cortesão. The connecting line for me was my own conception of ‘full emptiness’. Although my own views do not carry the single-word precision (matrix) or the brilliance of Foulkes and Cortesão, I hope the reader will comprehend my aims in defining fullness of emptiness as a bond between matrix and pattern. Finally, I want to make a couple of basic points. Throughout the text, I have used the masculine pronoun for the sake of brevity. I use the terms

HOW I STARTED

23

‘verbal group’ to denote groups that use language primarily and ‘art group’ to denote group analytic art groups. ‘Structural’ or ‘structured’ art groups are those that are not group analytic in principle and practice and function through tasks or themes. I use the term ‘concrete images/imagery’ to denote paintings, drawings, sculptures, etc., which differentiates from verbal imagery. The terms ‘patient’ and ‘client’ in this book are on a par. The term ‘group member’ incorporates patients, clients and students.

Chapter 2

Early formulations and developments

If Foulkes had known about this he’d have gone out and bought a paint brush. D’Arcy (1976, private communication)

Introduction I will begin by considering two theoretical perspectives. The first is based on the theories of Foulkes; the second expands these into group art therapy and group analytic art therapy. I intend to highlight the varying dynamics within groups that set language as the dominant feature and within groups that set the production of visual concrete images as a dominant focus. I am indebted to Harold Behr and Lisbeth Hearst for their kind permission to reproduce extracts from their paper on Foulkes’ work (1983). They presented it so clearly that I felt I could not improve on it. Extracts of Foulkes’ other writings will emerge throughout the book, but here I am throwing the reader in at the deep end of group analytic theory. I will present a consolidation of my previous papers that are already in print (McNeilly 1983, 1984, 1987, 1989).

Group analysis Group analysis, or group analytic psychotherapy, represents a synthesis of elements drawn from psychoanalysis, social psychology, Gestalt psychology and general systems theory. The man who was chiefly responsible for bringing together these elements and formulating the basic assumptions, theoretical framework and clinical application of group analysis was S. H. Foulkes, a psychiatrist and psychoanalyst (Behr and Hearst 1983, p.1).

24

EARLY FORMULATIONS AND DEVELOPMENTS

25

Foulkes was born on 3 September 1898 in Karlsruhe (Baden). He left Germany in 1933 to settle in England, where he died on 8 July 1976. The earliest and strongest influence on Foulkes’ professional development was that of the neurologist Kurt Goldstein (Goldstein 1939) whose assistant he was for two years. Goldstein emphasized the importance of the whole organism and its relationship to the total environment. How much Foulkes was influenced by this view, and his application of it to the field of group analysis, can be seen from the introduction to his monograph of 1948: ‘The healthy organism functions as a whole and can be described as a system in a dynamic equilibrium…it has constantly to adjust actively to the ever changing circumstances and environmental conditions in which it lives’ (Foulkes 1983 [1948], p.1). Certain concepts which are central to group analysis clearly have their origins in the holistic philosophy of Goldstein: the ‘group as a whole’ is at the centre of the therapist’s attention, and can be viewed as an ever-changing field of figure ground relationship in which, now one, now another aspect of a dynamic network comes to the fore. The part cannot be observed in isolation from the whole; the therapist also forms a part of the total field of interaction. The analogy of the group as an organism, a system in dynamic equilibrium, and the analogy of the nervous system as a network, an apparatus functioning as a whole, have both been incorporated as key constructs of group analytic theory. Following on his association with Goldstein at the Neurological Institute in Frankfurt, Foulkes underwent training as a psychoanalyst in Vienna, and then returned to Frankfurt to take up a post as Director of the Psychoanalytical Institute there. …Foulkes propounded the view that the individual is not prior to society. He perceived the individual as born into a network of communication processes which profoundly affect his nature from the moment of birth. The individual and society are both abstractions which have become separate only for semantic reasons. The frame reference for the individual is the natural group in which he lives. The therapy group is a microcosm of society as well as, at times, representing the patient’s original natural group. (Behr and Hearst 1983, p.2) In 1921, Freud wrote ‘Group Psychology and the Analysis of the Ego’. He was one of the first people to study group psychology in relation to the group leader. Foulkes pointed out that Freud’s two main groups of study were the army and the Catholic Church and in his work he was focusing on

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the projection of the ego ideal, later to be equated with the superego, on to the leader: He [Freud] did not attempt to explain the dynamic processes taking place in groups… Group analysis stresses the psycho-analytic model which perceives of mind as a dynamic system of relationships and communications in flux, rather than mind as a mental apparatus made up of goal-directed instinctual drives. Psychoanalytic viewpoints which stress the importance of complex internal and external object relationships are especially applicable to group analysis, with its emphasis on communicative processes which transcend the individual. A major input to the theoretical model developed by Foulkes comes from group dynamics developed by Kurt Lewin’s field theory, and the importance attached here to the group and its leader: the group analytic model of leadership preserves a delicate balance between the disruptive and the cohesive forces within the group, which Lewin related to the leaderless and ‘strongly’ led groups respectively. In fact, the group analyst, at least in the mature group, is unobtrusive in his leadership, and in this sense approximates more closely to the leaderless end of the spectrum than do other psychoanalytic models of therapy groups. Out of the wealth of psychoanalytically oriented approaches to group therapy, it is possible to recognize three main treatment concepts: 1. therapy in the group, 2. therapy of the group, and 3. therapy by the group. Each of these three approaches has a distinct theoretical framework. The first one, psycho-analysis in the group, preserves the dyadic model of the psycho-analytic relationship with regard to each patient in the group and places the therapeutic responsibility fairly and squarely with the analyst. There is a deliberate discounting of group dynamics and a rejection of the social psychological perspective as introducing an unwarranted element of mystification into the treatment process. (Behr and Hearst 1983, pp.2–3)

In keeping with these definitions, I would like to present group art therapy equations to illustrate each approach. The first example is art therapy in the group, which I illustrated in Chapter 1 by describing my membership of a training group. The group is seen as a collection of individuals who are involved in their own artwork and who are visited throughout the session by the therapist. The dialogue, when it occurs, is between the dyad of therapist and group member. I see the dynamic structure that has been postulated in


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psychoanalysis in groups as comparable. One difference may be that the art therapist would not necessarily align himself with the classical psychoanalyst’s role. The art therapist’s role in this type of group approach, generally speaking, is based upon non-intrusiveness into the image-maker’s creative space. Facilitation and permissiveness are central to the art therapist’s role here, and the most important dynamic is seen to be with the image-maker and the image. The group, therefore, is set in the background. In the second model, that of psycho-analytic treatment of the group (the so-called Tavistock model), it is the ‘group as a whole’ and the analyst which form the psycho-analytic dyad. The ‘group as a whole’ becomes the entire concern of the analyst, who directs himself essentially to the transference relationship. In this relationship the therapist’s talk is strictly defined as that of interpreting in the here-and-now the transference which the group establishes between itself and the analyst. (Behr and Hearst 1983, p.3)

There are some parallels with art groups structured around Gestalt therapy. In my experience, such groups use the complete imagery with a central aim or objective. The group leader promotes each individual to ‘go into’ their completed image in order to be in the ‘here and now’ and to adopt different ‘beings’ as part of the therapeutic process. For example, ‘Be the house – be the girl – be the tree – be the road,’ etc. The focus is similar to that of art therapy in the group in that one of the roles of the therapist is concerned with promoting the dominant interaction between the image-maker and the image. Although this is not a group analytic technique, this method goes some way towards an awareness of commonality within the group. Here, there is primarily the ‘leader of the group’, which maintains a group more in keeping with a Bion-type group (Bion 1961). As with the previous group type, the leader’s role is not of importance when questioning either what images are produced or the effect of the leader on the creation of the finished product. The benefit that Gestalt art groups may have is that with the channelling of active imagination upon personal images, this may lead to changes of direction and resonances not initially foreseen. These techniques may be of great value to those groups of people who function best in a containing structure, i.e. adolescents, students and other groups formed according to common factors. However, I should say that my experience in Gestalt art groups is limited to past experiences some years ago. There may be new developments in technique and theory, so I apologize if my account is simplistic.

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With the group analytic approach to art groups, the group is also structured upon ‘figure ground’ and ‘here and now’ configurations, but in a more unconscious, free-flowing way. Because the images have not been called upon via a technical request – ‘Be the tree – what do you feel now as the tree? What do you feel with the sun in the background?’ – the dynamic roots will stem more from the unconscious. This would be in contrast to cognitive connections through active imagination. The third approach, that of the Foulkesian group analysis, takes as its frame of reference the group itself, with the treatment of the individual through the group processes. This approach occupies an intermediate position between the other approaches, in its respect both for the dynamics of the group as a whole and for the individual, as a legitimate focus of therapy. (Behr and Hearst 1983, p.3) Germane to these concepts is the notion of the individual as a nodal point in the network of his group. The infant–mother relationship is the first social relationship in the same sense as it is the first sexual and love relationship, and the family as a group is the earliest social environment within which the individual defines his identity and gains a sense of group belongingness. Every event involves the group as a whole. Man can only fully realise himself within the network of the group. Mutual understanding arises through a process of communication which occurs on all levels, from the deepest intra-psychic to the social. This communication takes place within the complex network of interpersonal relationships. Illness is therefore conceived as occurring within this network and must be treated in it. (Behr and Hearst 1983, p.4)

With the addition of a contribution by co-author Malcolm Pines, Behr and Hearst’s paper was expanded as a book chapter, which adds greater substance to the original publication (Gazda 1982). Although I shall address particular points of Foulkes’ terminology throughout the book, I suggest that one reads the chapter by Pines, Hearst and Behr in Gazda (1982, pp.132–78) for a more comprehensive account and also Foulkes’ original writings. On the whole, I follow closely Foulkes’ views when exploring group analytic art therapy in theory and practice. The earlier types of art group that I described give prominence to the individual and their imagery, placing the group in the background in lessening degrees or apparent insignificance. I will now discuss the group analytic art group in more detail.


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Group analytic art therapy The opening quote of this chapter was said to me by my friend Jean D’Arcy when she worked in one of my art groups in the therapeutic community. However, Foulkes did know about therapeutic art groups in 1945. I have only recently learned this by reading Susan Hogan’s book History of Art Therapy (Hogan 2001, pp.209–10). Hogan presents a valuable account of an art group session which Foulkes attended; this is worth reading but is too long to be reproduced here. Hogan reported that the session was not untypical and pointed out how the images acted as catalysts for discussion. She noted that Cunningham Dax visited this group but did not adhere to such methodology. Dax was influential and promotional for Edward Adamson, who, as I stated earlier, developed the individual, non-intrusive school: art as a form of healing. In his book on the Northfield Experiment, Tom Harrison presents details on the art therapy undertaken there. Sergeant Laurence Bradbury’s input to the Northfield is acknowledged further in Harrison’s book with personal accounts about these early art groups. However, Bradbury stressed that ‘art is therapy’, declined the use of the term ‘art therapy’ and preferred not to use the phrase ‘art therapy’. (Harrison 2000, p.203). How could Bradbury not be influenced by Foulkes in developing a group analytic model while in direct contact with Foulkes? Was Foulkes seeing the richness in the concrete imagery in using it covertly, or not? Possibly, Foulkes was too busy furrowing his own verbal channels in the early days of group analysis. However, I was able to locate one direct account of Foulkes’ involvement with an art group in Introduction to Group Analytic Psychotherapy (Foulkes 1983), under the heading ‘Another Trigger Action’. Foulkes draws on Sergeant Bradbury’s notes: The group, though much larger than the previous week, were slow to respond to the drawings, and the paintings which M. showed caused little excitement. Even the most depressed of M.’s works were accepted with little interest, though everyone agreed with the drabness of the colouring in each case and no-one suggested that the pictures could be cheerful, despite the cheerful element in each. Pte. G., realistic and usually reserved, made a long, cynical and determined statement on the unresurrected dead – which appeared in one of M.’s drawings. None of the group opposed or seconded G.’s opinions, but though he appeared to be serious enough himself, the group was inclined to be amused… Practically everyone took part in the discussion excepting B. himself.

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The group was not interrupted and ran on to tea time, i.e. two hours. Deviation caused by Maj. Foulkes’ remark: ‘You don’t think much of English women?’ after the subject had cropped up on one of the paintings. It is interesting that Sgt. B. labels this as ‘deviation’. He was an artist in charge of the art classes and brought out beautifully the patient’s spontaneity in their paintings. (Foulkes 1983, pp.137–8)

Although Foulkes’ work is central to my findings, some of my formulations owe a debt to Bion’s writings, particularly his Experiences in Groups (Bion 1961). The classical psychoanalytical models of Freud and Klein and other ‘object relations’ (e.g. Winnicott and Balint) theorists will also be drawn upon. However, the framework of this particular type of art therapy is my own. In reviewing my earlier papers I feel that many of their central concepts have stood the test of time, with regard to both my own development and that of the art therapy field in relation to groups. There is little in my original hypotheses that I have changed, apart from those areas that were perceived as antagonistic or critical. My group analytic training has led me to take a wider view of my own theories, making me less afraid to receive criticism or abandon that which was misleading or untrue. Rather than adding major changes to my original views, I have expanded these into group analysis and, in turn, opened new doors that had not been approached through verbal groups. Progressively, I have adopted and discarded four main titles to explain my theoretical framework and technical application. These have been: ·

group art therapy

·

group art psychotherapy

·

thematic and non-thematic art therapy

·

directive and non-directive approaches to art therapy.

The final model is now called ‘group analytic art therapy’. One of my main aims with these earlier papers (McNeilly 1983, 1984) was to highlight theoretical and technical splits between practitioners rather than to make them greater. In some cases, there was a positive reaction; equally, however, a similar proportion of readers took offence, as they felt that what I was saying questioned long-established beliefs of art therapists using structured techniques.


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Group analysts may already be aware of my paper published in Group Analysis (McNeilly 1984) which is a consolidated version of my earlier paper on directive and non-directive approaches to art therapy (McNeilly 1983). The term ‘non-directive’ is on a par with my present term ‘group analytic’ but no longer carries the same opposition to ‘directive art therapy’. In my early years as an art therapist, I was the leader of a group and set topics for the group to follow. As this was within a psychotherapeutic community, I had to devise a new system (see Chapter 3) that was more in keeping with the whole community dynamics, which didn’t sit comfortably with directives. It was not appropriate to maintain the idea that an art group could function in the relative isolation of the art room with directive modalities, in contrast to the emotional currency of the whole therapeutic community setting. Nor was it enough to open the doors of the art room and facilitate an asylum mentality (a secluded safe room) as our forefathers did, removed from the dynamic issues of the whole therapeutic community. In these formative days I was in constant flux between how much I directed my groups through the various techniques I had learned while at college and, in contrast, the next stage of developing non-directive groups. I had not learned this more arduous and unpredictable task from my teachers or books. In fact, within our therapeutic community, Foulkes’ theories did not percolate through to me for one or two years. My motivation in directive art therapy was to provide a vehicle for the experience of intense feelings that could not be accommodated only by language. This directive, uncovering approach caused many conflicts for my groups and myself, with numerous consequences. These included catharsis of questionable long-term value, intolerance of the uncovered feelings and withdrawal or flight from the group by patients. What emerged was not all negative, but in retrospect I wonder about the validity of group responses resulting from such a strong controlling input from me. An overidealized aspect of what I was seeking was to gain access to unconscious material on demand. I believe that the reverse of this actually happened and that my current group analytic approach is far more productive. I think that in many ways the directive approach served as a safety net (McNeilly 1983, 1984) for me as a beginning art therapist and did not deal adequately with transference and counter-transference issues. With the directive approach to art therapy, the therapist principally establishes a dyadic process between himself and the individual members of the group. I had read little in art therapy literature that dealt with relation-

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ships in the art group. On the whole, the lines of communication were between the therapist and the patient, focusing on the artwork and its themes. By providing the theme, the therapist comes to be seen as the provider or ‘good mother’. In my elaboration on the directive dynamics, I was exploring this with respect to dependency. Bion (1961), in his description of the ‘dependent group’, highlights how a group establishes a strict discipline, whereby a patient is talking to a doctor and limits his conversation to topics that maintain the ‘dependency basic assumption’. At the same time, this group contrives to demonstrate that the doctor does not know his job. The group continues, familiar and unchanging. A balance of tensions is established, which Bion considers to be an equilibrium between group mentality, group culture and the individual. The directive art therapist, who concerns himself primarily with the individuals and their artwork, may collude with them, thus creating a similar dependency fuelled by the method. The cross-relationships in such a group are minimal, with a search for approval going back to the figurehead (McNeilly 1983, 1984). In my earlier views on the use of themes, I suggested: The process of introducing themes into an art group is a forced entry into the group (in such groups that do not necessarily warrant such a directed technique), leading to ever-increasing demands from the members and severely restricting intra-group relationships… Consequently this over-idealized transaction from the individual member of the group towards the therapist sacrifices the dynamics of the inter-group relationships upon which the very existence of the group matrix depends. (McNeilly 1984, p.205)

Today, I am not convinced about my findings that themes constitute a forced entry. There are many groups and particular client groups, such as children, adolescents and groups formed according to a common factor such as anxiety management, where themes are beneficial in assisting the patients to reach a secure position. Also, my views on the sacrifice of group dynamics of the intergroup relationships have been modified to include only groups that are attempting to assist interrelations, but my initial views still apply to the therapist who introduces a beginning theme in a dogmatic manner without due consideration to the group’s existing culture. Therapists who set necessary themes for their groups and have no pressing concern for the dynamics of interpersonal relationships have to contend with different sets of dynamics. When working with patients who have potential for insight


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and motivation for change, the use of starting themes given by the therapist should be questioned. It is not the theme that is in question, but its technical use. For the remainder of this chapter, I will highlight specific theoretical developments of my own from their points of origin. I will expand upon these in later chapters. From my initial stance of directing groups and moving into newer, searching forms of art therapy, many questions arose: for example, why was it necessary for me to suggest starting themes for the groups I conducted? The answers came with the change to group analytic methods. My first step in preparing to abandon the use of themes given by me was to look upon my need as a way of imposing order. I wrote: I feel strongly that the adoption of a theme is not primarily for the patient, but for the therapist. One could also see it as the child in the therapist, which to deal with his inexperience needs a structure in order to function and be valued as a professional. (McNeilly 1984, p.207)

In abandoning my earlier position of being the initiator of themes, I was appearing to renege on my therapeutic task. I was no longer the leader of the group, providing the recipe for the group procedure. In Foulkesian parlance, I was now the ‘group conductor’, a term Foulkes coined and that equated the group analyst to an orchestral conductor. One of Foulkes’ definitions of group analysis certainly helped me to bring order to my creative chaos. He says: It [group analysis] grew out of and is inspired by my experiences as a psychoanalyst, but it is not psychoanalysis of individuals in a group. Nor is it the psychological treatment of a group by a psychoanalyst. It is a form of psychotherapy by the group, of the group, including its conductor. Hence the name: group analytic psychotherapy. (Foulkes 1986, p.3)

I was now groping in the dark while trying to create an approach similar to Foulkes’ definition. In order for me to establish my new methods, I had to devise a structure that would facilitate the art groups group analytically. Simply speaking, I brought group analytic principles into the core therapeutic community programme by promoting a ‘themeless’ use of the art groups. Compared with the directive theme-setting approach, or the free-floating expression by individuals who at other times used the art room in their own way, it eventually became a more powerful and focused therapeutic medium.

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In considering my imposition of themes in my earlier years, what was of interest was the particular choice of theme at a given time and what caused me to focus upon it. Often, it would have been thought out clearly in relation to the community dynamics, and there was a value in this that was hard to give up, as there was often a sense of achievement. However, a sense of failure ensued if things didn’t go to plan. There was great pressure on me from the patients to come up with motivating and interesting themes every week. I struggled on with directing groups with my ingenious themes, but the longer it persisted the more contrived I felt I was becoming in the first two years. I continually had to justify my professional position by what was seen and heard to be coming from my lips. When I sat with the group during the verbal part of the session, and in a mechanical fashion went from one person’s image to the next, I felt very much like the art-therapy forefathers I spoke of in Chapter 1, who did the same thing to me with their ‘floating visits’ in the art group sessions. With the eventual adoption of the group analytic method, it felt so invigorating; it was as if caution was thrown to the wind. Even now, when I go into an art group, my pulse increases with trepidation.

Direction In its simplest form, direction is inherent in the process of any therapeutic intervention. Simple questions such as ‘How can therapy help?’ and ‘How can I change?’ and doubting statements such as ‘There is no hope!’ are all concerned with existing and new directions in people’s lives. Retracing my earlier formulations, along with my therapeutic practice, the dynamics of direction were crucial but in need of much revision. My initial formulations upon group analytic art therapy may have been perceived as offering no direction at all to an individual. Foulkes stated that in a group interpretation, individuals will pick up on that with which they resonate the most, and hence the direction evolves more naturally. In recent years, I have become more comfortable in giving individual comments in the group, but I still believe that one should always have the group dynamic in mind. I still limit making categorical individual interpretations, as this would perpetuate the notion that the group analytic art therapist is the key holder of the ‘right’ interpretation. Previously, I resisted responding and reacting to the individual, believing that it would increase the ‘dependency basic assumption’ (Bion 1961). To individualize in a group may result in dynamics of envy, of feeling special or victimized by the conductor and perception of


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the conductor’s real and fantasized power. This highlights my disagreement with that part of Foulkes’ basic law of group dynamics, which speaks of respect for individuality (Foulkes 1983, pp.29–30), as it does not accommodate fully the destructive and negative issues in the group. Morris Nitsun coined the phrase ‘anti-group’: ‘My own interest has increasingly been in the negative and destructive attitudes that arise in relation to the group itself ’ (Nitsun 1991, p.7). In discussion with group analytic colleagues, there is a view that Foulkes did not address destructive forces adequately. Now what has all this to do with directiveness or non-directiveness? The idea of a directive and non-directive art therapist is outmoded and should be abandoned. Philosophically speaking, non-directiveness does not exist. Time goes forward and to live is to go forward in a direction. Even a choice, consciously or otherwise, to opt out of the system or the wish to regress has a directional aim of going back or sideways to escape or to find lost hope in order to go in a more gratifying direction. Whosoever speaks or, at times, is silent in a group is directing it. One answer may lie in moving the focus away from building theoretical models upon: ·

directive models – theme settings with controlling therapists

·

non-directive models – group dynamics, in which the individual is sacrificed for the good of the group and the therapist stays in the background too much.

We should give more attention to direction in art groups (inclusive of thematic/structured art groups), staying in tune with the natural frequency of the group’s direction and also to charting new directions that emerge in the group process. There is a need for a revision of ideas about directive and non-directive art therapists. The two stances can be parallelled in a belief that direction is unavoidable – it is how to get somewhere that is the difference. Even when I sit through a group in total silence, it is not because I have the intention of being non-directive. It is because the group is going in a compatible, analytical and meaningful way and does not need me to introduce new directions. Groups may find it difficult to accept their healing capacities, especially if there is a tendency to project strong superego attributes on to the therapist. The silent therapist is then seen as disapproving; if he sees the group as mature and healthy, then he may be perceived as condescending. When I do speak in a group, either on the individual’s imagery or on total group process, this is directive – it can be no other way. It may or

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may not carry a message of my agreement with the existing group direction. The group now has choices – they can accept and change course if that is desired. If the statement from me is one of illuminating things from another angle, all that is required is to sidestep and see things differently. The group may welcome my comments as they may feel stuck. Some responses to the therapist’s statements include resistance, increasing the intransigence, or the group going on its merry way and leaving the conductor feeling alien. There is also the fact that the conductor just hasn’t got a clue as to what is happening and his words seem to be there as a way of earning his keep. It is important to know when to shut up. One last point I will make about different art therapists is that the titles refer only to a minor starting component; the more meaningful similarities and differences are often left unexplored. Possibly, there is a need to separate them in order to have a nurturing of specialities. Turning now to some key points in group analytic terminology, which I addressed in earlier papers (McNeilly 1983, 1984, 1989), I would like to discuss briefly two areas: matrix and the resonance. I have expanded these ideas significantly in later chapters, but first I offer a few brief comments on structural aspects of the matrix while equating it later in anatomical terms (pp.37–8). With verbal groups, the matrix is constructed with the following: ·

What is seen: numbers of people in the room and its contents, chairs, central coffee table, the therapist

·

What is partly seen: mannerisms, body language, proximity of group members to one another

·

What is not seen: individuals’ thoughts, unconscious, memories, internal associations, reactions to others.

The fit between these three areas gives emphasis to the strength or weakness of the group matrix. With the art group, the same principles apply. However, there are additional dimensions to these three categories: ·

What is seen: this is increased by a potentially different room and extra materials for expression that activate the other senses. Paint, clay, water and crayons evoke reactions to touch and smell; people may copy things in the room; they may taste paint and clay rubbed on the lips or from chewing the brush end or


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pencil. The large array of materials within the physical matrix establishes and maintains the dynamic matrix above the foundation matrix. I will describe these terms in due course. An additional component is that the individual has to create his own space to be held or shared within the group for the creation of the images. The parallel in verbal groups would be silences in which people withdraw to paint their own mental pictures. As far as I am aware, Foulkes did not use the term ‘physical matrix’, although he would have considered a number of the points raised with his concept of the conductor acting as a ‘dynamic administrator’ in practical matters of conducting the group (Foulkes 1986, p.99). ·

What is partly seen: this is as in verbal groups, but some elements may not be seen while everyone is busy creating their images. For example, one doesn’t see a formulation of a memory or thought that has been activated through a scribble or chewing a paintbrush. More difficult to see is how a smell that is within the room leads a person back to an earlier experience or memory, and then the subsequent formulation of a picture.

·

What is not seen: the extra dimensions of media help us to accommodate that which may not be seen in verbal groups and which becomes lost in silences and silent assumptions. For those who do not create an image or who end up with a blank sheet, this brings a new form to the analytic group. That which is not seen in the verbal group can be assumed to be either present in non-verbal communication or silence. With the added dimension to the group of pictorial imagery, much of what would go unnoticed can now be located in how the images are created (or not) and in whether the image is created in a particularly structured way, is abstract or is apparently meaningless to its creator. For further reading on this, see McNeilly (1989).

When I spoke previously of the matrix as a physical anatomical equation, I was referring to how the perceived body shape of the group matrix changes while containing its skeleton and vital organs. In rethinking the physiological parallel with the matrix, I would like to offer a new adaptation to the concept of resonance. Resonance is one of the central catalysts within the dynamic matrix. In the past, I studied the matrix and resonance separately. I

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now see resonance on a par with being the cardiovascular and nervous systems of the group body or matrix. My earlier commentary on the matrix was more descriptive of the dynamic matrix. What can and cannot be seen in the foundation matrix is more complex. Therefore, the deeper layers within the foundation matrix resonate, waiting to be summoned to the surface via some common catalytic triggering process. The paradox here is that this apparently silent structural process is, in effect, extremely loud (or full) when it presents itself in the conscious arena of the group (see Chapter 11).

Resonance I have called resonance the ‘Language of Dynamic Silence’ (McNeilly 1983, p.84) because it is akin to a silent and symbolic language. I believe it is also paradoxical in nature – how can language be silent? With this in mind, an equation can be drawn with Foulkes’ views on the autistic symptom of neurosis, when he says: ‘The language of the symptom, although already a form of communication, is autistic. It mumbles to itself secretly, hoping to be overheard; its equivalent meaning conveyed in words is social’ (Foulkes and Anthony 1984, pp.259–60). Roberts (1984, pp.211–19) highlights resonance as a concurrent dynamic in art groups as opposed to a consecutive contribution in solely verbal groups. In the group analytic art group, members can create pictorial images; each contributes to or emanates from a central power. Consciously, each member either does his own work or copies; while this is occurring, a common pool of experiences is being formed. Issues under the surface are waiting to be sprung. What in the end appears to be resonance, I would equate with a magnetic field. Primarily, the concept of the magnetic field is that the magnetic power lies with the two surfaces being attracted to each other, rather than the power force ‘being within’ and pushing towards each other. I have developed this analogy to resonance elsewhere, when I was exploring fusion and confusion in individuals and groups (McNeilly 1987, unpublished work). I suggested that resonance was the power drive within the magnetic force field and that fusion was the enactment of the resonant drive and draw (push–pull) of magnetic objects. In Chapter 8, I shall expand these ideas concerning the attraction of opposites, polar balances and encounter-alienation.


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Conclusion A conclusion is an act of stopping, which is not my intent here. Nevertheless, there is a degree of stoppage in closing one chapter before moving to another. Looked at another way, a line of enquiry has various stages and levels. Therefore, I hope that my enquiry in this chapter has shown how the early stages of theoretical evolution have moved, along with the practical applications. In the next chapter, I illustrate in more detail just how this practical evolution developed.

Chapter 3

Practical developments

Therapeutic community I recall my first contact with the Henderson Hospital Therapeutic Community in 1976 when I was on placement as a student art therapist. This was probably the best-known therapeutic community in the UK at the time. It was set up to work with people who were diagnosed with personality disorders. I was given a brush (no, not a paintbrush) and was told to sweep the floor. What was I letting myself in for? This led to one of my most interesting learning experiences as a student. It equipped me, somewhat crudely, to take on my first art therapist position some months later. From a very naive position at the Henderson, I had to begin my trade as an art therapist while being involved in both large and small psychotherapy groups and various work groups (cooking, maintenance, gardening, cleaning), and contextualizing this as a whole. Not an easy task! Throughout this book, I will expand upon art therapy within the therapeutic community. Henceforth I will use the term ‘community’ in place of therapeutic community. In Chapter 2, I began the line of enquiry concerning art therapy development within this community. In this chapter, I shall elaborate the more practical and technical components. The community where I worked from 1975 to 1986 had been established in 1954 and followed the ideas that had been developed by Bion, Foulkes and colleagues at the Northfield Hospital, Birmingham, England. Unlike the (sociotherapeutic) Henderson model, this community was psychotherapeutic. A simple way to describe the differences between the two is to point out that the social model was more concerned with how people interacted and changed their behaviour, while the psychotherapeutic model, although concerned with similar issues, dealt more with internal psychic change. Neither model was exclusive, with a blurring of philosophical/theoretical approaches.

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PRACTICAL DEVELOPMENTS

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Although the community’s original purpose would be seen on a par with that of the Northfield Hospital, many changes occurred over the years. Various schools of therapeutic theory and methodology had been used, but the core of the community, with its large (community) meeting and small groups (creative therapy, art therapy, psychodrama), had formed the psychotherapeutic community framework (matrix). It was my original task in the community to create a new art therapy service. I had been told that my predecessor had functioned in an individual manner, which kicked against the group and therapeutic community model, in the same way as I described in Chapter 2. During these early days, I had little sound theoretical knowledge, working spontaneously (impulsively in disguise at times) and firing on all cylinders. I began with numerous techniques in attempting to establish art groups and projects. Over the years, this developed into the small group analytic art group, which I elaborated on in Chapter 2. The following structures were part of this process.

Open art group This was a three-hour session in which the community members, including staff, came to the art room to create freely. The full range of media was available. My main role was to act as a facilitator, but I also created images. These sessions were often enjoyable, but at times they were difficult to contain. Often, people would use this session to act out pent-up feelings. With this in mind, one had to be continuously aware of the complex community dynamics. As the task of this group was activity-based, the creative image-making being foremost, it was not appropriate to take up these acting-out issues verbally in situ. However, sometimes this was unavoidable and the group was misused as a way of ‘splitting off ’ thoughts, feelings and actions from the mainstream of the community. It was necessary for me to facilitate a bridging of many of the healthy and unhealthy issues that arose in this open art group with the other parts of the system. There were often times when my free-floating role was changed by a request to become the art therapist and individualize with one of the people in the room. For example, I might be asked to contain a crisis evoked through the image created or to pass some interpretive comment. Often people would feel they were not getting enough from me in the small art group. I recall many people over the years going through the process of splitting and re-engaging, and issues of transference were played out (I will return to this

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in Chapter 4). I recall that two women would produce 40–50 images in one morning, with an expectation that I would talk with them about each picture. At such times, I was uncomfortable and became more convinced that this was not art therapy. At times of these patients’ distress, it would have been unkind of me not to respond, but the rather blinkered idea of me dealing with such polarized positions seemed to be creating an illusion that therapy was an action between two people to the exclusion of all that was happening around us. In fact, I have my doubts about the whole concept of such an open art group being a form of art therapy. I would suggest that it be more appropriately described as art activity in groups. When I was called to step forward in my capacity as art therapist, this could be seen as an inadvertent attack on the task of the group’s personal image-making. I developed different techniques to deal with these struggles for individual attention in the open art group. At critical times, people made direct requests for me to talk with them or discuss their picture. At such times of difficulty, I would call a stop to what was happening in the room in order for the group to deal with this issue. Later, we would bring this event into the community groups, which was the accepted forum for wider discussion. Another method in response to the wish for individual attention in this setting was to accept what was being offered but gradually to extend my attention to include others. I would talk with others at the same time, gradually making links between myself, the requesting patient and others. The debate here is not whether one should give individual attention rather than place the group foremost within the dynamics of this type of art group; it is more a matter of not being seduced into changing the ground rules of it being an open art group for personal expression and, as such, not analysed directly. The art therapist’s dominance here, and the illusions that individual attention equals art therapy, are counterproductive.

Community art group This group, which ran for two hours each week, had a similar structure to the large (verbal) community group. The basic difference was that the (daily) verbal large group was based on a free-floating group analytic model, whereas the large art group had a beginning, a middle and a conclusion. In the beginning stage, which lasted for 15–20 minutes, the group discussed what it intended to create. The middle section comprised the creation of imagery. This would last for 45–60 minutes. The final part was a verbal exploration, lasting some 30–40 minutes. The time given to each of


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these three stages was not adhered to rigidly; occasionally, the session time was extended by a maximum of 10 minutes. I adapted this three-stage model to the teaching side of my work with student art therapists and other experiential workshops. The content of these sessions varied each week, ranging from a large spontaneous group painting on one piece of paper, through large collective paintings on a community topic or theme and individual image-making on a community topic, to writing and performing a play in order to enact a current community issue. Sometimes, at times of crisis, the group was transformed into a solely verbal group. My own role here was clearer than in the previous type of group. I was the art therapist along with co-therapists. However, I was also an active participant, making my own images, and as such had a persistent inner struggle as to whether I was being an art therapist at these times. In these art groups, although not fully conscious of it at the time, I was developing group analytic art therapy, theory and practice. One simple link here would be that the group would often portray, either literally or symbolically, the events of the community. My work would then be guided towards exploration of individuals’ and the whole group’s state of being at that time.

Small group analytic art therapy group Approximately 18 months to 2 years after I had started at the community, we reached a point that required major changes. One of these areas of change involved the small groups and the art therapy component. Part of my own thinking was that there was conflict and confusion between the community art group and the open art group. People were aiming for more individual attention in the open session. The community art group was felt to be too large (with up to 40 members). As a result, we could not cope adequately with the many issues that arose. By now, the art therapy component had become well established in the community. The intention was to modify the art therapy and thus capitalize on the value of the previous two types of groups. The intention was to move the focus on to the smaller group format (no individual therapy was undertaken within the community). At the same time, we wanted to promote the value of understanding the group process, individual and group dynamics as shown in art groups, and how the art groups portrayed the community dynamics concretely. The next problem was how to create these small groups in order to fit in with the community framework. I felt it could be a mistake to create new groups, as these could be split off from the central core. The end product then would be

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too many groups, which I felt would dilute the community more, when our aim was toward consolidation. The answer was staring me in the face: Why not use the existing verbal small-group framework and I become a part of it? At that time, four small groups were meeting four times a week. My intention was to use one session of each group as an art group. The aim was to cause as little disruption as possible. This change also allowed the existing small groups to function together on a different level, either on a playfully enjoyable level or on a deeper, symbolic, unconscious way of being. In line with my own development, I was moving the art therapy more into the forefront of a psychotherapeutic approach as well as providing a key therapeutic venture for the whole community. I would then be the one therapist who had direct links with all the small groups and the large group. In this respect, it was rather like being a linchpin or channel for much of the community dynamics. Each small group was conducted by two therapists, who were now put into an interesting position. The practical way we developed this was to give each small-group therapist the freedom either to attend or not to attend art therapy with their group. For a number of years, one group had only one therapist while the others had two co-therapists. With the former art group, it was decided that I would conduct it on my own. With two of the groups, only one therapist came with each group. With the fourth group, both therapists came. As time went by, and I developed and trained as a group analyst, I was often the most senior verbal therapist. One interesting dynamic was that as well as being the art therapist for all the group sessions, I conducted one of the small groups with a co-therapist for the other three days for two to three years and on the art-group days stepped back into my art therapist’s position. Flexibility and blurring abounded. The reactions to changing to small art groups within the existing small-group system ranged from a warm welcome to hostility and being non-committal. Some of my co-therapists took a passive position if they attended the art therapy session and were critical about what happened in their absence if they did not attend. Others saw the session as having no psychotherapeutic relevance. Others still saw the opposite, doing much more than they could achieve solely through words. Some therapists saw the whole deal as a debasement of art therapy in its purest form.

Theoretical and practical refinements In the first year or so, the early stages threw up teething problems for everyone concerned. Conflict arose as a result of my efforts to adapt some of


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the structural format of the large art group while others tried to imbue or graft characteristics of the open art group in/or on to the new small art groups. At the beginning of each meeting of the small art group, I would ask the members to sit down and to pool their thoughts to decide what they wanted to do: individual pictures, group painting, a set topic. This decision was to be made in 15–20 minutes, as in the large art group, followed by the same middle and end stages. A difficulty arose when the group attempted to turn these sessions into open art groups. The main issue here concerned the boundaries of the group and the acting out that went with it. (Like the verbal groups, each session lasted 90 minutes.) This would be evidenced through lateness, absence, leaving the session early, making tea in the middle of the session and playing music during the session, to name just a few things. Some of these actions were not seen as acting out in the open art group, but in the small art group they became boundary issues and part of the ongoing exploration of each session. These early stages were often extremely difficult, until I found an adequate working structure with newer methods of group exploration of boundary issues. For practical purposes, the allotted time was not conducive to having a three-tier structure. This was out of line with the other verbal small- and large-group methodologies which did not have a requirement at the beginning for people to consciously conjure up a line of direction. It was a mixture of seeing the folly in trying to hold on to this starting component along with my own frustration that led me to the phrase ‘I want you to use the materials in the room to do whatever you want’. When considering the roots of my frustration, I may not have been fully conscious of the unspoken (unconscious) message at the time: ‘I’m fed up with this continuous struggle. Use the materials in the room; do what you want.’ Let’s just keep it as an interesting thought. Since its inception, I have always used this phrase in the first session of a training course in art therapy and in one-off experiential groups with new patients joining existing groups. I then suggested that the verbal start of the group be abandoned when people came into the room. Once everyone had finished creating their images, we would reconvene in a circle to share what had been produced. In this way, everyone was free to do individual work, just as they were free to talk or not talk in other small verbal group sessions. This changed the structure of the group to a two-tier process. Techniques such as group paintings and themes were not ruled out but were often suggested at the end

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of a session to be followed up next week. This was rarely initiated by me. By and large, this arrangement maintained itself and is one I have since used generally. It is more in keeping with accepted group analytic methodology than the original models (see Chapter 2). Another major difference from how I functioned in the earlier transitional period was that I no longer created my own imagery, apart from thoughts and words, during the session. It may be thought that the direct initial statement ‘Use the materials in the room to do whatever you want’ is not in keeping with group analysis. I do not believe this, just as I do not believe that the group analyst religiously refrains from an initial contribution, verbal or otherwise. As psychotherapists and group analysts, we are silently giving the message to our client/ patient that the space is theirs to use as they wish, just as my statement is not a demand that they must create imagery. The outcome of this two-tier process was that group members came into the art room at the starting time and began creating in their own way. There were clearer time boundaries adhered to with more discipline. With the final model, acting out had decreased to a minimum, and structure and process were in better harmony. In the end, a greater understanding of the group purpose had come about. The initial teething problems were rife with the threat of freedom and power, but gradually this led to a greater trust and security. The ‘final model’, as I was to call it, became more refined over the years, until it became group analytic art therapy theory and method. Gradually, I was able to develop my approach until it was accepted as a central modality, which I later went on to describe as one of the four cornerstones/pillars in the general structure of the therapeutic community model – i.e. art, drama therapy or similar techniques, work groups and socialization – with language interweaving all of it (McNeilly, unpublished work, 2003). The foundations are the individual and collective unconscious. I believe that the group analytic model I developed was continued at the community after I left. In the remainder of this book, I shall elaborate on more complex techniques. By showing evolutionary aspects of the art therapy developments, I hope to illustrate how a rather crude system was beginning to find form.

Brief notes on methodology In the original drafts of this book, I toyed with the idea of presenting a structural breakdown of how the theory and practice of group analytic art


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therapy were carried out. This initially revolved around my own personal adaptation and application. Granted, the reader will pick up components of this throughout the book, in the theoretical formulations, illustrations on aspects of technique and the clinical examples. What emerged was a table of dos and don’ts that compartmentalized stages in the structural and dynamic administration of the group, the activity part of the session when the members are creating, and the verbal section of the session. On one level, this ended up sounding somewhat crude, didactic, prescriptive and almost ungroup analytic. As I developed a whole range of components that had to be considered, complex issues that needed further elaboration before publication were revealed. However, for the sake of brevity, if one considers that the technique in a verbal group is built upon a fairly equal playing field in the use of language, then one can frame the method of technique in a linear way from the start to the finish of the group’s session. In the group analytic art group, this is added to dramatically with the active/ creative parts, the evocation of other senses (smell, touch, sight), the concretization of instincts and emotions in the imagery, and at times the opening up of primitive processes. Therefore, there are many more considerations to be accounted for. It is my intention to publish these findings at a later date. In conclusion, I hope that by showing how things began and evolved in those first few years I have created a blueprint for later developments. Although the community was an initially difficult arena to be involved in on many levels, I owe a great debt to it, as it allowed me to sow the group analytic seeds that eventually grew and were harvested. I hope that my descriptions of these processes are clear and do not need further conclusive elaborations. In respect to my own development, by my third year at the community, I was, consciously and unconsciously, beginning to take part in the meta-communications between all parts of the community. This in turn allowed me to hone in to more specific modalities and, hence, to refine the group analytic art therapy section in the coming years.

Conclusion I trust that my account of what I aim to do is also counter-balanced by that which should be guarded against – don’ts. The language of dos and don’ts may give the impression of a methodological recipe, which, if not adhered to rigidly will go wrong or have repercussions. That has not been my intent.

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The stages and points within the 90-minute session are set within a dynamic continuum. At times, my attention and work are on one particular focus; at others, they are bouncing from one dynamic to the next. The solid structure adhered to comprises the starting and finishing times and the two-tier process of image-making and talking. In the next chapter, I focus on one of Foulkes’ central points of theory: the ‘group as a whole’. In the preceding material about the structural development along with a mechanical breakdown of what happens in my art groups, I have demonstrated how I have been enabled to embrace such theories. The ‘group as a whole’ will be conceptualized and utilized if one has the basic rudiments in place as stated.

Chapter 4

The group as a whole

Within Foulkesian group analysis, the idea of the individual and the group as separate entities is not one of contention. As Foulkes says, ‘There can be no question of a problem of group versus individual, or individual versus group. These are two aspects, two sides of the same coin’ (Foulkes and Anthony 1984, p.26). This broad encompassing view has not been shared by other group psychologies and group psychotherapies, such as those of Bion, Wolf, Slavson and Ezriel. The study of groups, with subsequent debates about the individual or group dominance, has only entered the psychoanalytic, psychotherapy forum since approximately 1920. Trotter’s (1921) The Instincts of the Herd in War and Peace, Le Bon’s (1895) Group Mind, McDougall’s (1920) Organized and Unorganized Group Mind and Freud’s (1921) ‘Group Psychology and the Analysis of the Ego’ are all key works. Each of these theoreticians produces a rich complementary or contradictory study of group psychology. It is beyond the scope of this chapter to explore in depth these four perspectives. Since the original theories emerged, others have developed these ideas into their own psychotherapeutic approaches to and with groups. One only has to compare Trotter’s (1921) The Instincts of the Herd in War and Peace with Bion’s views on the congregation of groups to envisage a common denominator being located in the presence of the leader (therapist). To illustrate this, I quote from Bion: The congregation of the group in a particular place at a particular time is, for these mechanical reasons, important, but it has no significance for the production of group phenomena… In fact no individual, however isolated in time and space, should be regarded as outside a group or lacking in active manifestations of group psychology. Nevertheless, the existence of group behaviour is, as I say, clearly more easy to demonstrate, and even observe, if the group is brought together and I think it is this increased ease of observation and 49

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demonstration that is responsible for the idea of the herd instinct, such as Trotter postulates…which amount in the end to the idea that a group is more than a sum of its members. The apparent difference between group psychology and individual psychology is an illusion produced by the fact that the group brings into prominence phenomena that appear alien to an observer unaccustomed to using the group. (Bion 1961, pp.168–9)

Trotter had postulated the herd instinct as a fourth instinct along with self-preservation, nutrition and sex. Whereas the latter three were seen as primitive instincts coming from within, the herd instinct came from without and was deemed social (Trotter 1921, pp. 47–8). Trotter says: This intimate dependence on the herd is traceable not merely in matters physical and intellectual, but also betrays itself in the deepest recesses of personality as a sense of incompleteness which compels the individual to reach out towards some larger existence than his own, some encompassing being in whom his perplexities may find a solution and his longings peace. (Trotter 1921, p.113)

Bion and Trotter appear to be in sharp contrast here. Each of the original group theories will help us to understand why modern-day group psychotherapists adhere either to the ‘individual in the group’, or the ‘group as a whole’ frame of reference. The purpose, therefore, of pursuing the line of study into the ‘group as a whole’, before moving into the ‘individual in the group’, is mainly a belief that individuals emerge from groups. There are a number of hypothetical convolutions in looking at the ‘group as a whole’, which may appear as if we are running round in circles, only to cover the same ground when we come to study the ‘individual in the group’. Some simple questions include the following: Do group dynamics exist as a unique process, or are they a collection of individual psychodynamics?; are there group transferences, or are the individual transferences in harmony or disharmony?; ‘how can groups feel, as opposed to individuals expressing a unified feeling?. My views are that groups do not feel; only individuals within the group feel. However, the group forum creates an arena in which emotions are generated. In the process, individuals, if amenable, avail themselves of the opportunity to experience feelings that they may deny or evade elsewhere. I have elected to use the ‘group as a whole’ in a similar way to weaving a carpet. With this analogy in mind, the group dynamic is one part of the

THE GROUP AS A WHOLE

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overall tapestry in which the individuals are both the weavers and the material that gives substance to the carpet, i.e. the warp and the weft. To a degree, I will reverse this process when focusing on the ‘individual in the group’ in the next chapter. I intend to highlight the special place that group analytic art groups have in promoting, expressing and making visual the dynamics of the ‘group as a whole’. In Chapter 11, I develop a new variation of the ‘individual in the group as a whole’. In my work on specifics within art therapy groups (McNeilly 1989, pp.156–66), I presented a study of the ‘group as a whole’ expression of specific imagery. These were: ·

the blank sheet

·

the shocking image

·

the recurring picture

·

the copied picture

·

the written word.

Although I looked at the specific relevance of these to group analytic art groups, I would venture that such dynamics are evidenced in verbal group analytic groups in other ways. I will return to this when I speak of transitions from group analysis to group analytic art therapy in Chapter 8. One cannot choose one’s family, and the ensuing life struggle of maintaining and developing one’s individuality, while belonging to groups, is highly significant. There are numerous groups in life in which we have greater or lesser choice to either stamp on our own individuality or remove ourselves from the group. There is a logical strand in beginning our study with the ‘group as a whole’, as individual choice must, therefore, evolve from tied group membership. Within the Jungian concept of the collective unconscious, one’s individuality can be ascribed to a personal unconscious that emerges from, and is part of, the greater collective unconscious. Foulkes drew parallels between his theories on the foundation matrix and Jung’s collective unconscious.

Theoretical perspectives: definitions There are various definitions of the ‘group as a whole’. It will be of interest to highlight and compare some of these views.

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When Foulkes is looking at the group and individual in new perspectives, he says: We have become used to thinking of intra-psychic processes, ipsofacto as inside the same individual person, inside the same skull as it were. If we make such an assumption we beg one of the most important questions which arises. The fact that these mental processes are taking place physically in each individual brain is undoubted. If we hear an orchestra playing a piece of music, all the individual noises are produced each on one particular individual instrument; yet what we hear is the orchestra playing music, the conductor’s interpretation, etc. Not even in terms of pure sound do we hear a simple summary, a summation of all the individual waves which reach our ears, but these are modified significantly, being part and parcel of a total sound. In truth what we hear is the orchestra. In the same way mental processes going on in a group under observation reach us in the first place as a concerted whole. Those familiar with Gestalt psychology will find no difficulty in understanding that the whole is more elementary than the parts. With this insight we have arrived at one of the basic concepts in group psychotherapy without which all other observations are misinterpreted or insufficiently described, namely that what we experience in the first place is the ‘group as a whole’. (Foulkes and Anthony 1984, pp.25–6)

Bearing in mind Foulkes’ definition, it is easy to see how the score of group analysis can be transcribed to group analytic art therapy. Furthermore it can be seen in the uniqueness of the individual as portrayed by the visual imagery. Foulkes appeals to the creative side of the group psychotherapist with a musical analogy, addressing the abstractions within language and other non-verbal communication. I wish to avail of the creative analogy by picking up on the visual, pictorial and symbolic aspects of the whole group. Visual artists, unlike musicians, rarely come together to create collective images, apart from when it is to express a collective message. These collective messages are often of a social or political nature, and then such power often can be channelled through large group systems. Examples include graffiti in towns and cities, the political art expressed in fighting oppression and expressing beliefs and in advertisements. Individual artists may have evolved as part of a collective project, either as a result of using a communal studio or because they were drawn to one another through similar artistic beliefs and ideals. Here, the ‘group as a whole’ is a silent but ever-present force holding the individual and, thus, nurturing his development.


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In Freud’s introduction to ‘Group Psychology and the Analysis of the Ego’, he says: The contrast between individual psychology and social or group psychology, which at first glance may seem to be full of significance, loses a great deal of its sharpness when it is examined more closely. It is true that individual psychology is concerned with individual man and explores the paths by which he seeks to find satisfaction to his instinctual impulses; but only rarely and under certain exceptional conditions is individual psychology in a position to disregard the relations of this individual to others. 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, in this extended but entirely justifiable sense of the words, is at the same time social psychology as well. (Freud 1921, p.95)

Freud expands on McDougall’s (1920) group mind ideas. In McDougall’s opinion men’s emotions are stirred in a group to a pitch that they seldom or never attain under other conditions; and it is a pleasurable experience for those who are concerned, to surrender themselves so unreservedly to their passions and thus to become merged in the group and to lose the sense of the limits of their individuality. The manner in which individuals are thus carried away by a common impulse is explained by McDougall by means of what he calls the principle of direct induction of emotion by way of the primitive sympathetic response…that is, by means of the emotional contagion with which we are already familiar. (Freud 1921, p.112)

The formation of a ‘group as a whole’ as a healthy functioning unit occurs when care, consideration, appreciation of one another, challenge and acceptance are generated. This is a form of love. I am drawn strongly to Freud’s comments at the end of his section on suggestion and libido. Here, Freud brings together the ‘individual in the group’ and the whole group dichotomy by resting this on a wider concept of love. He says: We will try our fortune, then, with the supposition of love relationships (or, to use a more neutral expression, emotional ties), [which] also constitute the essence of the group mind… Our hypotheses find support in the first instance from two passing thoughts. First, that a group is clearly held together by a power of some kind: and to what power could this feat be better ascribed than to Eros, which holds together everything in

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the world? Secondly, that if an individual gives up his distinctiveness in a group and lets its other members influence him by suggestion, it gives one the impression that he does it because he feels the need of being in harmony with them rather that in opposition – so that perhaps after all he does it ‘ihnen zu Liebe’ [an idiom meaning ‘for their sake’; literally ‘for the love of them’]. (Freud 1921, pp.120–21)

The love or sake of others that Freud postulates is defined differently by Bion, who appears to keep the group phenomenon, with the individuals in it, on the level of intrapsychic or ‘pairing’, in action. In my view, the concern for others that Freud points to is described by Bion as ‘valency’. Bion says: I mean to indicate, by its use, the individual’s readiness to enter into combination with the group in making and acting on the basic assumptions; if his capacity for combination is great, I shall speak of high valency; if small, of a low valency; he can have, in my view, no valency only by ceasing to be, as far as mental function is concerned, human. (Bion 1961, pp.116–17)

Later, Bion (1961, p.136) describes valency as ‘a spontaneous, unconscious function of the gregarious quality in the personality of man’. Trotter speaks extensively about gregariousness. It is difficult to see whether Bion sees valency as something that is intrinsic from birth and hereditary, in so far as it increases or decreases man’s propensity to be part of a group, or whether he believes the spontaneous, unconscious components to have high or low valency according to object relationships. Is the individual’s valency aroused by an individual genetic propensity to be stimulated, or does the ‘group as a whole’ trigger off the individual’s readiness to enter into a combination with the group (Bion 1961, p.153)? If, according to Bion, the individual has an inbuilt low or high valency, then where does this place the individual’s progressions and regressions in the ‘group as a whole’? Possibly, Foulkes’ views on resonance can be compared here, in that the individual at different times will tune into different levels of functioning according to high and low levels of unconscious/conscious associations. In my opinion, the ‘group as a whole’, therefore, in Bion’s work is not seen as a model of psychotherapeutic significance to the individual and, thus, is reduced to mathematical equations of intrapsychic and pair formations. The ‘group as a whole’ is reduced to a point of convenience, turning it into a laboratory for the study of individuals and their intergroup behaviour.


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I have already alluded to the special place Kurt Goldstein occupies in relation to the influence he had on Foulkes, and especially to Goldstein’s book The Organism (see Chapter 2). Foulkes makes great use of this in adapting Goldstein’s theories to the group as a living organism. Almost midway between Freud’s ‘Group Psychology’ and Bion’s Experiences in Groups, Goldstein presented at Harvard University the William James lecture ‘Human Nature in the light of Psychopathology’ between 1938 and 1939. Goldstein says: If we consider the ‘we’ as secondary to the individual, the ‘we’ should by no means be thought of simply as an extraneous and secondary connection between individuals. It is not simply a sum made up of individuals. Real group life, social life, is not an accidental living together, nor is it based on voluntary ‘social contact’. A concrete group life may develop in the first way, if individuals happen to live together under equal conditions and feel impelled to help each other against common difficulties. Yet real social life, whether under these conditions or under those in which a social unit is constructed by means of a ‘contract’ [a therapeutic group] will develop only if some genuine communion between its members exists. If this is not the case, the whole structure is shaken when conditions change. (Goldstein 1963, pp.210–12)

The concept of ‘we’ moves the focus from the primary narcissism or autoerotic, on to the ‘not me’ experiences, to borrow from classical theory. This concept is essential in the group space between individual and the ‘group as a whole’. The newborn child is in a state of ‘we’ with the mother. Therefore, to reach a state of ‘I’ involves many intricate processes but can never be separated from the present and new ‘we’ situations. However, a process of weaning occurs both in physical and psychological terms between the infant and the mother/breast. In this process, the infant begins to develop a sense of another in the world and a development of the dual concept of ‘we’. With this, there is gradual intellectual/cognitive development through the weaning (similar to the reductionist phrase waning) to a greater sense of meaning. Therefore, the stage of weaning may be understood partially as being the early seeds of meaning. The ‘we’ I see as an outcome of weaning and a prerequisite to meaning. Further, Goldstein says: My assumption that nature is concerned with the individual may appear to be merely a metaphysical belief. Yet it is certainly no more metaphysical than the idea which ascribes to nature a lack of concern

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with the individual and sees as its goal the preservation of the species. (Goldstein 1963, pp.210–11)

Returning now to the group art therapy focus, unless the art therapist uses a group analytic approach in psychotherapeutically oriented art groups, he will have difficulty in understanding the ‘group as a whole’. For many art therapists, the art therapy group is a collection of individuals and a forum at a particular time for these individuals to be present. Here the therapist promotes a singular field of vision, rather like looking through a set of binoculars from the large-lens side. The therapist moves from one section of the group to the next, with a tendency to telescope on to single elements. Depending on the clients, this will define how the group works. Within this format, the therapeutic alliance is seen to be primarily with the leader (therapist), but with a promotion of the self-image expression. The background, which consists of other individuals intent on the same route, is not considered to the same extent. In such groups, each person may maintain separateness. This may be because coming close to one another threatens the wished-for individual relationship with the leader. If the therapist turned his binoculars around and considered the wider picture, then he would have a different concept of the factors mentioned above and thus require a different methodological approach in the ‘group as a whole’. It is possible to conceptualize this art-group method with the original group mind theories of Trotter and McDougall, which define such a group existing as a herd and being led by the art therapist, or each individual’s unorganized (ill) mind being brought into a collectively organized arena. However, as the separation is maintained through following the leader, it is difficult to see the unorganized group mind becoming organized, except via the leader. Possibly in line with Le Bon’s contagion theory, the individuals in their attempt to follow the leader, and the leader’s promotion of this, could be seen as a mechanism of defence against contagion by others. In applying Bion’s’ basic assumption theories, in such an art group where the art therapist is working with individuals in the group, it is simple to locate the unconscious/conscious forces. Dependency and pairing are but two of the basic assumptions. Art therapists leading such groups will find much in Bion’s (1961) Experiences in Groups to assist them. However, they should bear in mind Bion’s views on the work group, in which the group meets for a specific purpose or task. The basic assumptions of pairing, dependency and fight/flight inherent in all groups will potentially threaten the structure of the work group. If the art therapist gives consideration to his


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or her ‘group as a whole’, this may undermine the task of working with individuals in groups. The structural art therapist working with a group may very well see the field of the ‘group as a whole’, with its many dynamic properties of structure, process, transference, communications and interaction, as being of little consequence. The job of the therapist is to set the theme and promote and facilitate the creative process with the aim of helping the patient, but I do not intend devaluation through oversimplification. Much good work is engendered in such groups and, indeed, benefits more from the linear dyad (within the group) between patient and therapist. Possibly, art therapists who create such group techniques should take heart by seeing their ‘group as a whole’ either in maternal or containing methodologies. Structured art therapists working with groups may learn much from Winnicott’s views on the ‘good enough Mother’ (Winnicott 1965, p.145–6). However, it is not as difficult to be a good enough mother to one individual as it is to be such to eight people, all craving attention. This does not mean that the group analytic art therapist does not see some of his functional role as being a good enough mother or container. Let us consider the group analytic art group in more detail in the light of the ‘group as a whole’. The historical findings I have pointed to from Trotter, Le Bon, McDougall, Freud, Goldstein, Foulkes and Bion are all useful blueprints for the group analytic art therapist, as are individual psychodynamic theories. In addition, there are the artistic and aesthetic perspectives along with symbolism, mythology, folklore and fairytales. Political, cultural and religious concepts are also central to the practice of the group analyst, be it primarily verbal or with the added dimension of image-making. Always in the centre of our frame of reference is the individual with his unique characteristics and idiosyncrasies. The group analytic art therapist should use his theoretical knowledge and experience in the service of his group. He should speak the language of his group, even though his silent personal struggle is about explaining a group dynamic as Foulkesian, Bionic or Freudian – or even a mixture of all. For example, three separate art groups may produce imagery of three different types: ·

The art group produces strong images of achievement and hope for the future, e.g. a painting expressing pending marriage. One member draws a boxer having won a fight as reflective of getting better. Another paints a holiday destination, while another makes a clay figure of a rocket, indicating the return of

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his libido last night (which produced laughter). Another draws his child in Heaven who had died one year ago. There are overt similarities that indicate a cohesive and resonant ‘group as a whole’. However, the group joins forces to discard the conductor through ignoring him or his interventions/interpretations and, as such, rejects him. This is connected to unresolved disappointment that he did not succumb to various dependency basic assumptions in the past. In part, there is also a flight into health away from the previous fight to get the conductor to fulfil the ‘dependency basic assumption’. ·

The majority of the images are either abstract or show violent scenes, such as attacks, abuse, suicide attempts and being locked in a cage. Within the group’s talking period, following an atmosphere that could have been cut with a knife while the group was painting, there is a long silence, with individuals in closed off positions. The ‘group as a whole’ feels stuck and powerless. However, for those who produced the frightening/violent imagery, the silence around them is deafening, and it feels that the abstract image-makers are more helpless and lost. Ezriel (1950) coined the term ‘common group tension’ to refer to a ‘covert shared aspect of the group’. Therefore, the underlying destructive dynamic for the ‘group as a whole’ is presented. Bion’s fight/flight basic assumption is also applicable, with the pictures showing various images of fights and destructiveness. Possibly this is connected to a split in the group, with the abstract painters desiring to flee the situation. Foulkes and Anthony (1984, p.151) used the term ‘condenser phenomenon’ to describe a ‘sudden discharge of deep and primitive material following the pooling of associated ideas in the group’. They see the collective unconscious acting as a condenser, and things are opened up via the stimulus of the group. Further, ‘this phenomenon bears some relation to Bion’s emergence of the basic assumptions and to Ezriel’s common group tension’ (Foulkes and Anthony 1957, p.151).

·

An art group collectively produces images that are pleasing to the eye. Some pictures are vibrant while others are subdued but carry a serenity or calmness, e.g. a sunset. The vibrancy shows


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itself in a large sunflower and a picture of a singer in a large auditorium. Other serene pictures are of a person sleeping on a cloud, a person flying on a magic carpet, another gently caressing the horn of a unicorn. There is a great deal of concentration, and people feel pleased in the making of the images and the final outcome. The artist part of the art therapist may come into play in helping the group to appreciate the aesthetics and beauty of the work produced. This moves the dialogue on to creative achievement and highlights individuals struggling with pleasing self and others, and personal growth with the emergence of previous conflicts that had been obstructive. The ‘group as a whole’ becomes unified; there will be many reasons for having reached this point. In a similar way to the previous two illustrations, one may use various theoretical understandings to comprehend the ‘group as a whole’ and to apply this technically. Winnicott’s views on the creative space (space created in the group) and the transitional object (concrete images) may be of use, even though Winnicott does not apply these views to groups as far as I know. Likewise, if we consider Foulkes’ views on the foundation and dynamic matrix, such imagery is seen in terms of what the individual creates within himself and how he develops as being part of the whole group. By this, I mean that much of the individual imagery that is created is an expression within the dynamic matrix. Those global collective components are extensions of the foundation matrix, i.e. the magic carpet and the unicorn’s horn. Taken together, they are conceptualized within the ‘group as a whole’. Moving back to Winnicott’s perspective, if the ‘group as a whole’ is seen as a ‘good enough mother’, then individuals will use the space more creatively with a sense of security and nurturance. A possible result is that members use the space more courageously as long as the group is experienced as a good enough maternal holding environment.

Group analytic art therapy definition From the group analytic art therapy perspective, the ‘group as a whole’ is best defined as: an incorporation of all that occurs within the session, for its duration. This includes the group members’ past and present lives. The ‘whole group’ view promotes individual and collective free expression

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through pictorial and verbal imagery, with the union of language, that is the bonding cement of such a synthesis (McNeilly 1989).

The group analytic intent of making the uncommunicable communicable is, at times, more easily achieved in group analytic art therapy. This added dimension of visually symbolic interaction allows for the group analytic processes to be seen more easily and at times is faster and assists in concretizing the process of making the unconscious conscious. The group analytic art ‘group as a whole’ encapsulates the commonalities and universalities of individuals within the group, giving concrete form to past and present systems such as families, cultures, myths and archetypes. The ‘group as a whole’ symbolism in group analytic art therapy can reduce the persecutory fear that often emerges in group analysis when language is the primary medium. This may be because people are functioning on a pre- or non-verbal level, cannot locate the right words to describe a feeling, or are using language as a defence. Here, the fear of losing one’s identity in the group can be minimized with the expression of the individual’s image making. However, image making can also increase persecutory anxieties when disturbing pictorial symbolism is expressed. Helen Durkin tells us: In recent years the term ‘‘group as a whole’’ has become a familiar if not always well-understood concept in the literature of group psychotherapy. Lewin’s simple scientific statement that the group is different from (not more than) the sum of its parts implies nothing in the least esoteric, nor is it intended to suggest a dichotomy between group and individual psychology. Yet, to many, it appears to be an animistic concept suggestive of the old ‘group mind’ notion. Certain group processes arise out of the interaction, such as the tendency to set standards and to put pressure on members to conform to these standards, to produce leadership among its members, to develop subgroups, scapegoating, and the like. These processes are bipolar. They may be centrifugal or centripetal in nature, moving the group toward cohesion or disruption. Group analytic therapists deal with both the overt and covert aspects of these group processes in terms of depth psychology. Each conscious, preconscious or unconscious interaction is assessed in relation to the total network of the group communication. (Durkin 1964, p.313)


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Durkin’s concise focus will assist the reader to follow further ideas that I postulate on centripetal and centrifugal processes in Part Two of this book. Let us move on to less theoretical matters. As stated in Chapter 1, most of the practice illustrations included in this book are either cloned from clinical sessions or fictitious. However, the latter are valid because they reflect actual sessions that inspired the fictional structure.

Analogous ‘group as a whole’ equation If one takes a number of objects, such as a pair of scissors, an apple, a car, a watch, a lamp, a book, a pen and a cake, these all have their own characteristics. Place the same objects in close proximity to one another and they acquire a new and expansive set of meanings and significance, both in one’s greater awareness of their uniqueness and in their interrelatedness. For example, take the scissors, watch and cake. The scissors are practical and are used for making shapes in material for the sewer, for cutting plants, for trimming one’s hair. They may be used emotively to stab someone in a fit of anger or symbolically to launch a ship by cutting a ribbon. The main use of the watch is to show us the time of day. Practically, it may also be used to measure one’s pulse or the speed of a race. Emotionally, the watch appears to be highly charged when waiting for an appointment or exam – time that goes either too slowly or too fast – or the countdown for a rocket launch. Symbolically, the watch may carry magical connotations such as ‘time is a healer’ or the fantasy that by crossing the Atlantic in a seven-hour flight we have cheated time. Practically, the cake satisfies our hunger. Emotively and symbolically, it has endowed particular life events with great significance, for instance birthdays, christenings and marriages. There are other symbolic links such as ‘You can’t have your cake and eat it’ (life’s not easy, and there’s a choice to be made) or ‘It’s a piece of cake!’ (a task is easy). Using these inanimate objects in such an illustrative manner, will trigger separate associations. However, if we put together all three objects, not only will they have their own particular meanings but also we will develop new associations to the ‘group as a whole’. Further to this, if the other five objects are placed together, this expands the process infinitely. The similarity with group analysis here is that the conductor assembles his group and, at particular points, triangular arrangements (interactions) may form. Let us now put these three together with hypothetical interactions.

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Scissors – watch – cake Together, these may be linked to an eighteenth birthday gift of a watch (time), a celebration cake and the symbolic cutting away from childhood to adulthood (scissors). There may be a similar connotation at retirement, when one is presented with a gold watch, the professional cutting into retirement and old age and again the celebratory cake. On an emotionally charged level, these three objects may represent the slow ticking of the kitchen clock for a woman trapped in domesticity, baking cakes and preparing meals. Things reach such a peak that one day she explodes in anger with her partner and impulsively attacks him with a pair of scissors. As she lunges, he lifts his arm to protect himself and she strikes the watch on his wrist – shattering time. Each of the subsidiary objects in the background may contribute to such vignettes. The ‘group (of objects) as a whole’ creates a multidimensional process; rather than diminishing the uniqueness of each object, it increases each in structure in their interrelatedness. Each expands beyond the confines of its molecular structure into the space between and into the minds of individuals. In the group analytic art group, such imagery is constantly being expressed in visual and concrete form. Art group members often produce these objects (watch or clock, cake, scissors, etc.). Each person has his reasons for his own image, and in the verbal section of the session these are spoken of. With those art therapists who would expand linear exploration between the image-maker and image, this may help the individual to explore this, but the group will miss much of the interlinkings. For example, a hypothetical art group led in this individual manner might be as follows: John paints a cake with eight candles, one having been blown out, and the therapist encourages individual exploration. John talks about his birthday yesterday and associates with earlier birthdays. The therapist focuses on John’s feelings about the one candle being blown out. After some time, the focus moves to Sue, who has painted a Salvador Dali type of picture of fluid clocks and watches; the therapist promotes an exploration of her picture. Sue thinks of the clock in the foreground slipping off the table as representing time slipping away, while in the background a grandfather clock is at a standstill at eight o’clock. Further exploration by the therapist elicits Sue’s depression about the losses in her life, especially her grandfather. Everything is slipping away and security is shaky. The focus then moves to Hilary, who has painted eight pairs of scissors by tracing around a pair of scissors on the table (although hypothetical here, I actually recall this). All


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are painted in different colours, except for one blank pair, which she sees as herself. The linear exploration is difficult here, as Hilary says ‘Oh! It’s nothing really. I couldn’t think of anything to do, so I just drew around the scissors and then coloured them in.’ The therapist may take this at face value or he may look with Hilary at her need for repetition and the significance of the scissors being either closed or open. Much can be achieved in such a group, and structured art therapists can be extremely effective. However, the therapist being effective in such a linear/dualistic process diminishes what can be seen with the interconnections within the ‘group as a whole’. What may be missed with John is that the eight candles are representative of the total group number and in which John feels always snubbed, or ‘blown out’. The cake may be a symbol of the art therapist, of whom the eight members want slices. In John’s original family, he struggled to exist – he is the youngest of eight, always coming last in his experience. What were explored as feelings of loss and dependence on key male figures in Sue’s past, such as her grandfather, now take on a different perspective. With her interactions in the group, she is constantly unresponsive to taking from the other group members, and the ‘group as a whole’ are taxed by her apparent superiority. She struggles continually to impress the art therapist, which has the effect of cutting her off from the whole group. She knows the therapist likes Salvador Dali and Van Gogh. While the therapist is assisting Sue with her grief, he has been seduced into missing her wish to impress. The grandfather clock has stopped at eight – the group number – and is reflective of her stopping the group’s power with and for her. Sue also cuts out group competition for the therapist – she was an only child, the favourite by right. With Hilary’s painting, the numerical connection with the group is much more obvious. The ‘group as a whole’ is seen as everyone being the same but different in colour. Hilary manages to guard against others challenging her repetitiveness, as she always appears solid and cheerful. They feel they should not expect her to be the Van Gogh that Sue tries to be. People want to be accepting of Hilary because they feel comforted by her while she asks nothing special for herself. However, while everyone in the group wants to know what colour they are, Hilary herself is missed (or not noticed until last) as she is not coloured in. Marie asks: ‘Where’s Gerry [McNeilly]?’ ‘Oh! I forgot about him!’ says Hilary, with little obvious feeling. So here, Hilary is just an outline and devoid of colour, while Gerry is absent.

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Within the ‘group as a whole’, Hilary has taken up an ambivalent position. She hides her emptiness in repetitiveness and consideration for everyone with a pseudo- or false self. She is the archetypal giver of care. She coins a universal phrase: ‘Everyone seems to come to me for help.’ What may also be missed in not using a group analytic approach is transposing the colourless scissors (Hilary) to the figure position and, thus, establishing dialogue that would examine her emptiness and her evasion of transference feelings for the therapist. Unlike John and Sue, Hilary makes no claim to the therapist, whether image-wise or verbally. Also, the destructive component of the scissor symbolism is unexplored. Hilary was adopted in her second year of life and has spent the majority of her 30 years going from cold adoptive parents into care, ever-changing foster homes and then failed relationships. When looking at the ‘group as a whole’, I have taken the theme of three objects, while examining individuals’ own uniqueness in the context of the whole group. The multidimensional complexities of the many other sets of images are in the background but not separate. Also, there are the multiple contexts of each individual’s life within the therapeutic group as well as other groupings outside, for instance families. The ‘group as a whole’ theory and therapeutic practice therefore expand this triangle to the whole group. Once the linear/dualistic processes that I alluded to at the beginning have been widened to consider the covert content of the individual imagery, and how this reflects the ‘group as a whole’, we have to examine the particular reasons as to why this triangle and not another constellation is in focus. What is this focus portraying for the whole group? John, Sue and Hilary express universal character traits that each member in the group resonates to in varying degrees. To sidetrack a little here, the triangular dynamic should be interwoven with the whole, i.e. a triangular weft on the group warp. John portrays himself as someone who is constantly feeling rejected or acting in ways where he rejects and snubs himself out due to being the youngest child in the family, which reflects the group difficulties of his being in the youngest position with a constant problem in growing up. To grow up and take his fair share of the cake also has disadvantages, because he has to come to terms with sharing, competition and the loss of a privileged position. The motif of youngest child is in contrast to Sue’s presentation with the ‘group as a whole’ perspective. She encapsulates the only-child motif and represents a figure that continually succeeds in getting what the others want. In the therapy group, such people can be a source of great desire, envy and intoler-


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ance. Unlike John, Sue makes direct claim on the therapist. As the power of the only-child motif and the rejected-child motif are in operation, sibling rivalry is an issue. Thus, by its nature, the only child does not have family peers to compete with for his parents’ love, which has the potential effect of undermining the ‘group as a whole’. The position that Hilary takes up in relation to the ‘group as a whole’ is intermediary. She exists in a vacuum or empty space and represents, for the whole group, a canvas on which everyone will project (‘Everyone comes to me for help’). Hilary, and those resonating to her position, can neither experience rejection in the way John feels it, as there is an absence of primary figures, or be selfish like Sue, as she was never a sole focus in her primary family (apart from her expulsion/ rejection). The whole group may turn Hilary into a mascot that is invested with the current feelings of the group at any given time. She has come to stand for a no-man’s land to which the other group members can connect themselves at times of group conflict, either between the two positions presented or between other polarized group positions. In this instance, the ‘group as a whole’ sets as its foreground (figure) the triangle of rejection by others or oneself, greedy consumption of attention and passivity or conflict-free existence, activated by singular, apparently different, symbols (clock, cake, scissors). This is set on the expression of many other symbols (car, pen, book, lamp, etc.), which all combine to form a rich tapestry in the group analytic art group.

Therapist’s interpretive approach One of the most important functions for the group analytic art therapist is to promote the communication and sharing of the imagery, as opposed to carrying out what appears to be a substantiation of therapeutic skills, i.e. interpretation with each individual. With a successful group analytic approach, the group members are continually sharing and linking, confronting, evading, supporting and developing insights. For instance, in a mature group analytic art group, differences and parallels would be acknowledged by the group members. Numerical significance would seldom be missed; in the previous illustration, Hilary’s colourless scissors may well be acknowledged in the first instance along with her position in the group. John’s candle would be lit again by the group in helping him to deal with his self-rejection. As a group analytic art therapist, it is necessary to be the conductor with the same criterion as postulated by Foulkes. As well as feeling free to follow an individual line, this will not negate the ‘group as a whole’. A hypothetical

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group interpretation of the previous group illustration would be along the following lines: It seems as if the group is placing John, Hilary and Sue on to the front line for different reasons. With regard to John and Sue they are both struggling with rejection either by themselves for fear of entering particular struggles (John blowing himself out), or, like Sue, in rejecting everyone’s attempts to help in favour of getting me to herself (artistic impression of aesthetically pleasing images). Hilary’s way of dealing with her struggle with very early and present rejections is to either not colour herself (giving substance) or acknowledge a need for dependence (denial of me in her scissors painting). This also has the effect of getting rid of her anger about it all. The rest of you seem to be tuning into parts relevant to each of you, either verbally or in association with your pictures. One clear point of linkage is the collective agreement with the number eight.

Not all group statements/interpretations are as long as this. The words in parentheses would not necessarily be spoken.

Verbal group analysis equation Bearing in mind the complexities of such an art group I would like to parallel this with verbal group analysis. We will return to this in more detail when studying transitions in methodology (Chapter 6). Let us take our triangular constellation once again. When John, Sue and Hilary sit down in a primarily verbal analytic group, the same personalities and experiences are in operation, except for the visual evidence supplied in the art group. The media of words, silence and non-verbal communication are constantly in play. Initially, John may speak of his birthday (cake), which leads Sue to speak of birthdays representing for her a sense of lost time. Sue now turns her attention to me, while John, as is his wont, fades into the background. Sue impresses me with her use of language and tears to convey her feelings of loss; her need is inadvertently to get me to fill the space of her dead grandfather. All attempts by the others to interact with Sue are met with deafness as she carries on talking directly to me with an ‘and/but’ reaction to everyone else, that is, each suggestion is closely followed by ‘but this will happen if I do that’. Hilary empathizes with both John and Sue. Hilary wants John to confide in her through gestures and caring, and she expresses herself in an appeasing way to Sue by saying things such as ‘Time


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is a great healer. You have such a lot to be proud about.’ Here, Hilary extols Sue’s virtues and evades her own envy while she is having a relationship with me by proxy through Sue. When Theresa, another group member, challenges Hilary’s sitting on the fence between John and Sue, Hilary looks blank and, with an air of condescension, says: ‘What I never had I’ll never miss.’ The vignette could carry on but I think this is enough to highlight some similarities between art group and verbal group analysis. What is missing in primarily verbal group analysis is the large and, at times, overpowering array of concrete imagery. In conclusion, then, if we consider the ‘group as a whole’, we see a vast array of elements that have to be taken into account both theoretically and practically. Using a global analogy, if we hold the world in the palm of our hands, rotating it at times, we will see the vibrant dynamic constellation of all the individual countries and its oceans. We cannot see what is inside, but we know that what we see cannot be removed from what we do not see, i.e. oxygen, gravity, underlying rocks and the centre of the Earth. Of course, the Earth must also be seen in connection with the sun, moon and infinite galaxies. The earlier literature I spoke of takes us back to early seeds of group thinking, leading up to theory developed in between the 1940s and the 1970s. In later chapters, I speak of some more recent theory on the ‘group as a whole’. The ‘group analytic art group as a whole’ demands an expansion of vision beyond that which is expressed visually/concretely by individuals and how the therapist might respond to individuals. The ‘group as a whole’ concern of the conductor moves between the micro- and the meta-perspectives with each session. There is a constant movement between visual imagery and verbal language. Equally, one has to hone in microscopically on individual countries, mountains, seas, rivers, animals and people within this vast expanse) in keeping with the world analogy.

Chapter 5

The individual in the group: transference constellations

Introduction It would be safe to say that art therapy in its widest sense cannot be undertaken unless there is a voluntary wish to do so by the client. Here, individual choice can be seen to form a part of individual outcome, as there is a primary investment in the process by the client. Art therapy, psychotherapy and other insight-oriented therapies demand a high dividend from the client in the promotion of their self-healing properties. In some areas of mental health and physical treatments, the priority of the individual being seen as a contributor to his therapeutic destiny is less relevant. Some patients in psychiatry, as one example, are recipients of treatment that is often aligned to the passive, being-cared-for position. General hospitals are overflowing with patients being treated, but the main part they play in their treatment is to sign their name on the permission form for the treatment. They then move into a passive recipient position, developing a remarkable degree of trust. To be patient is to wait with equanimity, to be tolerant or to endure trying circumstances with an even temper. In many cases, genuine care is part of this process, along with a need for the removal of treatment responsibility from the patient. It would be much to ask a patient undergoing an abdominal operation to abstain from anaesthesia and to hold the forceps while the surgeon removes his appendix and to reassure the surgeon not to be anxious because he is no longer in the presence of an unconscious body. As psychotherapeutic clinicians, our work is more open, and we cannot operate unless our clients are mutually part of the process. In Chapter 1, I listed the many settings where art therapists work with an extensive array of patients. In all of these, I would venture that there are few art therapists who give art therapy on a par with giving medication. A nurse may say to the 68

THE INDIVIDUAL IN THE GROUP: TRANSFERENCE CONSTELLATIONS

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patient: ‘You are in safe hands with Dr Jones: he’s done this operation many times. He’s written and lectured widely in his field.’ Such views, although in many cases valid and of good intent, may have a depersonalizing effect, even though the intent was to allay the patient’s fears. Translated, the patient may interpret it thus: ‘I’ve no right to be worried, but what if I don’t wake up? If he’s done so many operations, he may just see me as his one-thousandth appendix. What if he slips? He has to make a mistake some time! If he’s so famous, will he be complacent?’ I will return to how such interactions and unspoken feelings play a part in the art-therapeutic process, both in individuals and groups, later in this chapter. For the individual entering therapy, he is in a so-called sick position as seen by himself and/or others, with the aim of returning to society cured. In many cases, what appears to be an initial illness of the individual is often a reaction against a sick group or system, as many family therapists will be aware. Here, in sickness, the individual is at the peak of an expression of his individuality. This may be a distorted attempt to remove himself from the source of the illness, e.g. the family system. Here, the individual and the group (system) are at odds and must be separated, either temporarily or permanently. As clinicians, we must place the individuality of human experience of every client in the highest position. The Christian ethic of doing unto others as you would have them do unto you is not amiss here, but there are many inappropriate derivatives of this. One example would be expecting one’s client to go further in therapy than is possible at that time, when the therapist has not himself reached this point in his own psychology. Here, the therapist experiences, by proxy, being pushed by an invisible figure in his own life. The attempt to make the client feel good through achievement (cure) may be an inadvertent aim for relief and cure of the therapist. There are many forms of art therapy where the degree of mutuality extends only to the agreement for the patient to begin art therapy and/or to attend sessions regularly. Further motivation, insight and change within the individual may not be sought actively, either by the client or by the therapist. However, unexpected changes may occur (e.g. in people with long-term psychosis, dementia, learning difficulties or autism) and may well be an added bonus. One of the greatest assets of art therapy is that the medium will open up more directly the individual’s creativity. This added bonus of the opened creative channel often leads from a beginning passive acceptance of the therapeutic agreement to an intrapsychic development through this previously

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dormant creativity. How much this opening-up mechanism is used as an art-therapeutic technique, as opposed to the stepping-off point for artistic (aesthetic) expression, is beyond the scope of this book. Many art therapists, as highlighted in Chapter 1, establish their techniques on the privacy of this process. They provide the space (room) for the individual to use with little input or interference from the therapist and a rightful respect for the individual. When I hear colleagues speak of not wanting to intrude or interfere with the patient’s creative space, I find this hard to understand in the art therapy setting, as the therapist is part of the therapeutic space. Sometimes, this approach may go to an extreme in making clients/patients into artists under an aesthetic framework. I am reminded of this dilemma each time I see art-therapy paintings exhibited on the walls of institutions and hospitals as artefacts. Would we frame and display our clients’ personal notes or the intimate intricacies of a therapeutic session? I am not against a client going on to be an artist through the process of therapy, but I am merely pointing to the art therapist possibly losing sight of the art-therapeutic process. The individual in group analytic art therapy is constantly using pictorial image-making, along with verbal imagery, to express his uniqueness but in context with the greater whole of the group. It may appear that there are restrictions and constraints on the individual with limited time to create the pictorial imagery (45–60 minutes), the knowledge that there is a verbal section in the session, the emphasis placed on sharing, and working on and through emotions and interpersonal difficulties, to name but a few factors. With individual art therapy, it may appear clearer as to what course events will take with the mutuality of the initial therapeutic contract. Here, the art therapist sees the individual’s distress or sickness face-to-face, and he knows his ground in a two-way system. These individual presentations are no less important when they occur in the group. In many instances, individual expressions will occur more quickly and at times with greater impact in the group than in individual art therapy. I have found that the individual in art groups on many occasions is less concerned with me as the therapist, which enables him to feel less constrained. Here, the individual frees himself from the vertical transferences one sees in individual therapy, moving it on to the horizontal plane of the group. The personal imagery in the group, once the individual becomes secure, is less governed by fears of being on-the-spot or seen into by the therapist. However, the individual may enter the group with a passive expectation to be ‘cured’ by the therapist, which may be hard to change (this also occurs in individual art therapy). This may affect the


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individual’s ability to use his creativity as he is waiting for the therapist to treat him. Returning to my earlier doctor/patient analogy, such individuals may make minimal concrete imagery with high expectations that the therapist will use his surgeon’s scalpel of interpretations, or they may fear to create imagery in case the therapist wields his scalpel. A note of caution should exist when setting up one’s therapeutic technique in order to enable the individual, whether in a one-to-one or a group setting, free image expression if there is little or no space to incorporate dialogue. Consider such freedom when dealing with patients with bipolar conditions; the severely depressed individual who exposes the depth of his depression with the image; the narcissistically disordered personality who for the first time reaches his emptiness, as indeed an anorexic person may do; or the person serving a life sentence for murder and who depicts the murder scene for the first time. These vignettes say a lot for the positive power of art therapy in different forms to tap such sources within the individual. If this is kept only in the individual’s privately creative space being transformed into images, and if the therapist resists further dialogue for fear of transgressing the imagery and its processes, this may leave the person isolated and alone with the distressing power in the imagery. There must be a transcendence of the individual’s internal world to relating to others. If this is not achieved through language, then other means should exist that bring safety and containment. These powerful messages must go to and through the group, and in the course of events these images are reintrojected in a modified and meaningful form.

Therapist’s role Such powerful art therapy processes may appear easier to understand and work with within individual therapy. Often, art therapists are tempted to function as individual therapists in the group, dealing with powerful imagery. Here, the art therapist may be concerned that the individual will not be cared for by the other members of the ‘group as a whole’. The therapist is concerned that the power of the image, with its associated feelings, will engulf the group. Dialogue with the focal person may appear too much for the group and the therapist feels a need to protect everyone. Even in individual art therapy, the exposure of such material may be experienced as too much for the therapist, and the client will be in tune with this. There may then be a conscious/unconscious limit of expression by the client. With such

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a conflict, the individual client censors himself and his imagery under the auspices of protecting the therapist from his powerful feelings. Until now, I have used a non-specific dialogue on a loosely defined client group. From here, I intend the ‘individual in the group’ thesis to focus primarily on art groups that can accommodate group analytic functioning and interpretation. The individual in this setting initially is equipped with a degree of insight and motivation to change. With the analytical emphasis placed on insight and motivation, it is necessary to consider transference and counter-transference in more detail.

Transference constellations The term transference constellations is my shorthand way of incorporating both transference and counter-transference. These complex constellations have been written about widely in the psychoanalytic literature but have been covered to a lesser degree in art therapy, although in recent years they have gained more prominence. Although groups as a whole will display complex transference constellations, it is the ‘individual in the group’ that is the base for transference dynamics. The ‘group as a whole’ can certainly acquire particular characteristics akin to individual conditions, for example, neurotic, psychotic, schizoid, anorexic or depressed groups. This can be seen when a group culture develops, which can be explained with the descriptive terms normally allotted to individual psychology. Such groups may fail to change once the culture becomes fixed. Individuals may collectively transfer and counter-transfer group processes and conflicts. However, I believe that these are generated by one or more individuals’ transference constellations. Increasingly, the literature has turned to consider the place of transference in groups. Scheidlinger (1974) has highlighted the role of the mother in groups, emphasizing the symbolic transferences on to the group as a mother figure. This is expanded further by Colin James (1982) in his paper on Bion’s ‘containing’ and ‘holding’ capacities within Winnicott’s theories, in the context of the Matrix. Transference and counter-transference have been studied and written about widely since Freud first brought these concepts to our attention. It is my intention not to elaborate on their psychoanalytic complexities but to expand the central thesis in order to explore specific links to art therapy and group analytic art therapy. For simplicity’s sake, let us recall Freud’s original formulations:


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Transference 1. The process by which a patient displaces on to his analyst feelings, ideas, etc., which derive from previous figures in his life; by which he relates to his analyst as though he were some former object in his life; by which he projects on to his analyst object-representation acquired by earlier introjections; by which he endows the analyst with the significance of another, usually prior, object. 2. The state of mind produced by 1. in the patient. 3. Loosely, the patient’s emotional attitude towards his analyst. (Rycroft 1968, p.168)

A succinct description of counter-transference follows: The term [counter-transference] was first used by Freud in discussing the future prospects of psychoanalysis (1910a). He said of the psychoanalyst ‘We have become aware of the “counter-transference” which arises in him as a result of the patient’s influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize this counter-transference in himself and overcome it,…no psychoanalyst goes further than his own complexes and internal resistances permit’… …as transference was, early on, seen by Freud as an obstruction to the patient’s free flow of association, so counter-transference was consistently regarded as an obstruction to the freedom of the analyst’s understanding of the patient. In this context, Freud regarded the analyst’s mind as an ‘instrument’ (1913b), its effective functioning in the analytic situation being impeded by the counter-transference. Freud did not take the step (which he took in regard to transference) of regarding counter-transference as a useful tool in psychoanalytic work. It should be emphasized that, for Freud, the fact that the psychoanalyst has feelings towards his patients, or conflicts aroused by his patients, did not in itself constitute counter-transference. (Sandler, Dare and Holder 1973, p.62)

As stated earlier, in recent years art therapists have paid more attention to the transference phenomenon, both in their clinical practice and in theory. Within the context of this chapter, I am only scraping the surface of a vast subject. The art therapist cannot be immune to such dynamics, but the use of these should always be in question. No matter how much the presence of the transference constellation is acknowledged and used, ignored or derided,

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the art therapist will, accordingly, be seen as parent, grandparent, extended relative, teacher, lover or enemy. When I read Wadeson’s chapter on group art therapy, I was struck by her views, which were very similar to my own. However, she refers not to Bion or Foulkes but to Yalom. This puzzled me, as there are sections that seem to echo Foulkes’ views on the dynamic matrix and also parallel my own application with the ‘group as a whole’ perspective to the art group. Wadeson says: The aliveness of relatedness found expression in the here and now sharing of the feelings about the group, about me, the complex issue of transferential feelings, including anger and idealization and views of one another. Obviously the communication of these images provided valuable feedback and an opportunity for shared perceptions of the group matrix which was a common experience. Opportunity for the sharing of images around a common experience especially an emotionally charged one, is rare for most people. (Wadeson 1980, p.268)

Earlier, she says: ‘The most important contribution of group art therapy, I believe, is the sharing of images’ (Wadeson 1980, p.239). I do not wholeheartedly agree, as the images are but a part of the whole experience. Later, Wadeson turns directly to transference images, when she says: ‘In my early work, I was insufficiently aware of the projections and distortions that are the transferential aspects of the therapeutic relationship’ (Wadeson 1980, p.271). From here, Wadeson extends the discussion on the transference constellation into illustrative material on the particular group in question. Although I felt close to much of what she put across in the whole chapter, I felt the study of the group theory, particularly transference, became bound or limited to the case-study format. Although this has been tried and tested format since the inception of art therapy, it often sets our methods and theories safely in the descriptive mode of writing about practice. Let me now turn to the British school of thought. Since 1984, we have seen a coming of age of new and at times exciting art-therapy literature. It is more common now to see transference/counter-transference in British art therapy literature. John Birchnell states: So far I have said little of the role of art therapist in art therapy or of the transference and counter transference phenomena which inevitably develop. Because art therapy is to do with bringing unconscious or


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partially conscious emotions nearer to the surface and daring to be more openly oneself, the super-ego, which derives from parental control, is forever in evidence and needing to be taken notice of. (Birchnell 1984, p.42)

The child focus is explored in a chapter by Margarita Wood. Wood states: The third aspect is the interpersonal exchange between child and therapist encompassing the therapeutic alliance, and the transference and counter transference within the alliance. The roots of this alliance in art therapy, whether this is implicitly or explicitly acknowledged, lie in the child’s creative imagination – that is, in the ‘capacity to form images and recombine these into new patterns’ (Plaut 1966 p.131) – and the child may find himself mirrored in this way for the first time in his life… The elements of the classical, dyadic transference, the projections of the child’s inner world on to the therapist, are present, but their expression and resolution take place within the picture making, unless they are clearly impeding that process, or are set in direct defence against it, or yet again, if the child is unable to enter that state in which painting is possible. (Wood 1984, p.69)

Foulkes’ views on group transference extend the parameters of individual transferences. In her chapter, Wood pleads for a wider, more expansive approach to these subjects within art therapy diads (patient/client). Her request is substantiated by the triangular constellation that emerges with the introduction of the concrete image. I have highlighted this triangular system in my earlier works (McNeilly 1983, 1984, 1987, 1989). In group analytic art therapy, these triangular systems are transcended via multiple imagery (see Chapter 8). Wood proceeds to extend her views on the transference through the image, eventually reaching the counter-transference: In his painting, the child makes his own vessel, but the art therapist is still subject to the overspill of unconscious content, at unconscious levels of interaction. It is often that which is formless and unbearable, as well as being unspeakable, and it is liable to arise when the child is pressed inwardly, or by outer events, beyond his capacity to imagine or to tolerate. The therapist may feel battered and useless for no apparent reason. The therapist is also in a counter transference relationship with the painting and can feel inexplicably exercised in response to it. (Wood 1984, pp.70–71)

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Although Wood requests a wider recognition of the transference theories, with which I sympathise, I am cautious about assigning to the imagery created the stature of a transference object in the same way as transference occurs with human objects. For me, the value in the image in triangular (i.e. patient, image, therapist) and multiple configurations (in groups) rests in them being powerful tools of communication in which transference constellation dynamics between human objects are expressed and worked through. This model of the image as a transference object is developed further in earlier papers by Schaverien and, in my opinion, leads to new and healthy discourse in the British art therapy scene. In three separate papers, Schaverien explored transference from different angles, while maintaining a centrality in which the image finally embodies the transference feelings. For example, in her paper on anorexia, she says: Eventually a transference may be mobilized to the paper, the pictures which initially were decorative may begin to embody feeling. By altering the currency and also the nature of the obsession, by the gradual substitution of art for food, the therapist is offering her client a different method of negotiating with the external or public world. (Schaverien 1989, p.16)

In my opinion Schaverien’s most important and controversial paper at the time was ‘The Scapegoat and the Talisman: Transference in Art Therapy’ (Schaverien 1987). A simple synopsis of the paper for brevity’s sake here postulates that the picture is the object of the transference. Subsequently, it may become a scapegoat. The scapegoat motif was envisaged as a positive enactment, not a negative acting out as has been thought. This is often understandable in negative transference terms within analytic groups in which the negative projections have to be worked through to the positive components in the scapegoat motif. Schaverien clarified that this enactment occurs through the process of symbolic interaction which turns the sacpegoat into a talisman. When she applies these views of the transference on to the scapegoat to the art-therapy process, she explains it as follows: A ritual transference such as those illustrated here assumes a faith, a belief that an object can become empowered. A belief of this nature involves magical investment in the thing, which effects a transformation of the mere thing into a talisman. This has considerable implications for the practice of art therapy. When art therapy is fully effective there is a transference of attributes and states to an object which, subse-


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quently empowered, becomes a talisman. Once an object is experienced as a talisman any act of resolution in relation to it becomes significant and might be seen as an act of disposal. (Schaverien 1987, p.75)

Schaverien acknowledges the more conventional transference ideologies, but she goes on to say: The pictures which embody feeling, consciously and unconsciously can be objects of transference and as such the central focus for intra-psychic movement to begin. There are times when the pictures merely exhibit the transference; these pictures enhance and widen the scope of psychotherapy but are distinct from the pictures which embody feeling. When the picture embodies feeling, and movement starts to occur in relation to the images created, it is then that change is possible through the medium of the picture itself. This is similar to the transference relationship to the therapist but here the focus is the picture. It is when a picture embodies unconscious forces that it can, in a very real sense, become a scapegoat… The image which is invested with power, the talisman image, may be disposed of by an act of destruction, but it may also be guarded and kept… Both these processes are integral parts of art therapy. (Schaverien 1987, pp.80–82)

There is one final point of reference to Schaverien: A person who cannot distinguish between things, internal objects, part objects and people needs the clear and safe boundaries of a therapeutic relationship as an outer container. The picture and the paper may be seen as an inner container. The burning of the inner container [Schaverien is making reference to a clinical illustration of a patient burning his picture] needs a carefully constructed outer boundary which is inviolable. The scapegoat transference in art therapy is a transference within a transference. (Schaverien 1987, p.90)

Schaverien develops her views more comprehensibly in The Revealing Image (Schaverien 1991,1999) and Desire and the Female Therapist (Schaverien 1995). This transference within a transference is just one point of contention that is taken up directly by David Mann in his critique of Schaverien’s work. Mann says: The notion that there are two transferences is a baffling idea which might better be understood if we allow for a muddling of terms. It seems clear that Schaverien is simultaneously confusing two different

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meanings of the word transference: lay parlance where transference is simply a placing of one thing on to another, and also the more precise analytic concept of transference meaning a particular form of projection, namely of infantile prototypes which re-emerge and are experienced with a strong sensation of immediacy. All transference is a projection but not all projections are transference. (Mann 1989, pp.11–12)

Mann goes further with this critique of a transference within a transference and he suggests that what Schaverien describes ‘are more usefully understood in terms of projective identification’ (Mann 1989). Mann emerges from the Kleinian psychoanalytic school of psychotherapy, referring to Klein, Bion, Ogden, Meltzer and Winnicott to augment his arguments. This is a valuable critique and, as such, another art-therapy paper devoted to the transference constellation. As one can see, the potential for transference in art-therapy literature is unlimited, and my intent with these brief references has been to highlight the prominence it has acquired in recent years. The writers I have cited acknowledge the presence of transference, but each approaches it from a different theoretical angle. As seen, this moves from the conventional transference dyad through the triangular configuration that recognizes the image between two people; the multiple transference constellation as seen in the art group; the image embodied with emotion as a transference object; and the transference within the transference, to the scapegoat and the talisman idea, as postulated by Schaverien, being redefined under the auspices of projective identification by Mann. These extensive views illustrate the healthy and exciting position of art therapy theory that has emerged since the late 1980s. These views are not indicative of a devaluation of our art-therapy forefathers, but we have now seen the emergence of a more dynamic approach to art therapy. Returning specifically to my own theoretical views and clinical application of the transference constellations, I acknowledge and accommodate some of Freud’s views but I do not believe that everything the client thinks about and expresses are transference expressions about me. Nor do I accept that the object-seeking aim of transference enactment is for the release of tension or unwanted energy from within the organism. Possibly the heightening of face-to-face arrangements in individual and group therapies has made it more necessary to re-evaluate these original concepts. The therapist has become more of a person rather than a voice and presence behind the couch.


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Focus on counter-transference Money-Kyrle (1956) refers to empathy as the ‘normal’ counter-transference. Little tells us that counter-transference is: ‘The appropriate or normal emotional response [of the therapist] to his patient. This can be an important therapeutic tool (Heimann 1950, 1960; Little 1951) and a basis for empathy and understanding (Heimann 1950, 1960; Money-Kyrle 1956)’ (Sandler et al. 1973, pp.67–8). On its simplest level, I become aware of the counter-transference when I experience a feeling in a therapeutic session that feels alien to me. This is a not-me experience, which at times tends to be that which my group or client disclaims. Although this may have conscious components, it is primarily unconscious and often not as clear as the transference dynamics. It is not just a feeling that appears out of the blue, and the therapeutic task is to explore this in context with the overall therapeutic structure. A simple example of this may be seen in drowsiness in the presence of a passively resistant patient who is dealing with underlying feelings of hate and anger. Both therapist and patient gradually enter a trance-like state. The therapist must be reasonably sure that his tiredness is not due to having too little sleep the previous night or a reaction to being overworked. The therapist should be cautious of calling his own transferences to the client counter-transference, as it may be a way of evading his own inner conflicts and unconscious processes. In structural art therapy, if the main therapeutic focus is aimed at guiding the creator of the image into a greater awareness of that image, then the transference constellation may not be clear. Indeed, counter-transference may be seen as counter-productive to the patient’s private creative space and, like Freud’s original views, is seen as an obstacle in the therapeutic process. For the power of the transference constellations to be a manifest part of the therapeutic alliance, a more direct bond has to be created between client and therapist. I often see a parallel between the psychoanalytic couch and art therapy that primarily sets the image foremost. The couch arrangement relies on the analyst being hidden (behind) and his presence verified through interpretations of what is presented verbally by the patient. The art therapist who sets the image foremost may also be hiding behind this technique and is verified through what he says about the image and the process of making it. Such dynamics may appear problematic when the art therapist working in this manner is faced with his client not creating an image because of unverbalized feelings of love or hate for the therapist. Further problems may arise in art groups that place the image foremost, with little attention being

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given to the transference constellations, when the therapist is faced with, for example, a collection of violent images because of unverbalized feelings for the therapist. There are psychologically oriented therapy groups in which it would be detrimental to explore the transference constellation. Two examples would be anxiety management and assertiveness groups. In some forms of art therapy groups, it would be well advised not to enter transference dialogue; generally speaking, these would be art groups that meet with the aims of having a superficial (surface) experience. Here, there is more structure, with the art therapist taking a leading, often cognitive, role. Structural methodology is primary, and the aim is for a pleasant experience, mainly at the conscious level. This does not mean that transference constellations are not present. Examples of such groups include children’s groups; student art groups; groups for physically challenged people, the main aim of which is to create together and improve dexterity (many such groups also require insight-oriented methods and, therefore, will accommodate transference constellations); and experiential art groups learning a structural technique. The experience and role of the therapist in dealing with the transference constellation is important. Art therapists with little or no psychoanalytical knowledge, experience and further training should take care in approaching this area. These waters are extremely deep and one may sink without proper understanding or interpretation – or through little knowledge of the currents, so to speak. Returning more specifically to the group analytic art group, the individual is considered within the transference framework. The patient’s thoughts and feelings are portrayed through concrete and verbal imagery; viewed within the context of the ‘group as a whole’, it is the individual’s contributions that are worked through to resolutions. I have heard it said that the power of the group is such and such. I have been in many groups in which there was an intense pressure from the ‘group as a whole’ to persuade me to act in a particular way, that is, through the power of the group. In many art groups, I have been placed in a particular position that the members agreed and maintained overtly and covertly. This would often be within a magical or mythical dimension. Certainly, the notion of a group transference is merited by the power of the collective wish for and holding on to me as that particular figure. Individuals within the group were attempting to locate their own variation of that particular transference figure. Considering the Jungian view of the archetype, one may view


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the mythical/magical nature of the individual’s transference constellations within the ‘group as a whole’. There is much about Foulkes’ and Jung’s ideas that can be paralleled. Foulkes’ views of man being a social animal in relation to a greater societal matrix may be equated with Jung’s personal and collective unconscious. The search for the mythical/magical nature in the art therapist is through particular transferences of the ‘individual in the group’ and the ‘group as a whole’. Jung tells us: Archetypes are like riverbeds which dry up when the water deserts them, but which it can find again at any time. An archetype is like an old watercourse along which the water of life has flowed for centuries digging a deep channel for itself. The longer it has flowed in this channel the more likely it is that sooner or later the water will return to its old bed. (Jacobi 1971, pp.38–9).

The transference constellations extend beyond the classical parental images into universal images; the art therapist is more likely to be seen with such an archetypal analogy (water course) in mind. When attempting to interpret or de-idealize such powerfully invested images, there have been strong resistances, as the need for archetypes is so great. Possibly, the strength in group numbers adds power to the drive for attainment of the wished-for figure at the positive end of the spectrum, i.e. the ‘wise old man’. With the negative transference, the power of the group to join forces as the individuals within to alienate me has been just as intense (note Schaverien’s earlier arguments on the scapegoat/talisman in Schaverien 1987, pp.152–3).

Hypothetical example of an art group As I will not focus specifically on the concrete images, I have not listed what each individual would have created. However, the general feel of the artwork was calm and passive imagery, with some conflict expressed, portraying, for example, a sunny country scene with a storm on the horizon or a couple sleeping in a bed with a dark shadow underneath. I am sure the reader can imagine such scenes beyond this. At the start of the verbal part of the session, the majority of the group are silent, with three members talking about their images in a flat and pleasant way. There are transference statements to me as the benign authority figure, with the verbal members wanting a direct comment from me on their work and, as a matter of course, seeking pseudoindividual therapy from me.

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The (surface) transference is a search for the ‘sage’ image, but somehow I am not convinced of the genuineness of these requests. Here, I feel drawn into a false-prophet position. Although I listen to and acknowledge the individuals’ dialogue with me, I begin to question some of the feelings about the position I am being placed in. This is an attempt to explore the background of the ‘group as a whole’, where the quiet members reside. I also highlight a group tension between seeking for a sage and silent passivity. This does not deal fully with this tension, as the group defensiveness is high. I now begin to feel irritated; as I was not irritated on entering the session, this has emerged in the here and now of the group. On the face of it, the transference appears positive and ego-boosting, but this doesn’t feel true. Metaphors like ‘the calm before the storm’ enter my head. I move my attention back to each quiet individual, considering recent events in the life of the group, pertinent aspects of each individual’s history along with the ‘group as a whole’. For each of the five quiet members, the last session was one of heated debate on sexuality along with the creation of powerful imagery. This ended in a stalemate position between John and Mary. Mary later acted this out by cutting her wrists, while John had a sexual liaison with another quiet group member. John is one of the verbal members today. These points become clear only after I voice some of my thoughts about things not being what they appear and question the split in the group. I voice my irritation that I feel I am being seduced into the false-prophet position. I acknowledge a certain anger here, in that it is as if I am being buttered up (flattered) but in fact I feel like a stooge (being taken advantage of ), and, therefore, being used through adulation. I ask about the anger that was in evidence in the last session and where it has gone. Possibly I am tuning into the remnants of it. There is an initial puzzled reaction to what I say, and people feel hurt that I don’t like their nice calm pictures. I question why, if they are nice and calm and there is, consequently, evidence of positive components alone, there is such an empty, flat feeling about this happiness? Gradually, the points of conflict and acting out from the last session begin to filter through. The three verbal individuals combine in their anger towards me for not supporting them or praising their work. The scales begin to be balanced more evenly as the events that originally formed the passivity come to the surface. It is now more apparent that the group has split into two. The quiet members were forming an allegiance with Mary through pained resignation using superficially calm imagery. John, being the leader of the other subgroup, was attempting to turn the recent experiences into


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non-events. John’s ego-boosting transference attempts with me were geared towards intellectualizing the session through my seduction into exploring solely his imagery. The counter-transference reaction was based on a tuning into the leftover ongoing anger and pain in the ‘group as a whole’. The remainder of the session became more solid, with the splits being explored through both the pictorial and verbal imagery. This then freed me from carrying the group’s negative feelings and conflicts, which, as a whole, individuals were projecting into the group space. Once this stage was reached, each individual was heard more in his or her own right, and the ‘group as a whole’ became more cohesive. Active and passive dynamics are projected, with the silent expectation that the nominated transference figure (here the therapist) will accept and unite these forces with no conflict being involved. The magical nature of this is that the ‘sage’ will calm the waters of distress and protect the members from one another. Here, the group transference takes on more of a symbolic significance. Another aspect of this type of transference configuration is the emergence of teacher and spiritual imagos. Thus, the spiritual transference is evidenced in the creating of the idealized priest or false prophet. The teacher transference may be seen in the wish to have the pictures praised, with consequential reactions to this not happening, for example, ‘You’re not accepting my picture by questioning other things!’ or ‘You don’t like me or my picture!’ Bearing in mind one of Foulkes’ basic tenets that the group and the individual psychology are not separate and in isolation from one another, we should also see that individual and group transference constellations are not separate entities. Although I focused mainly on group transferences with my fictitious group, these are the result of group processes and the individuals’ interactions within the group. The power of the group is the result of the power of the interacting forces between individuals within the group. One way in which Foulkes defines group transferences is as follows: Relationships in terms of the microsphere certainly do manifest themselves in the group. This is the sphere, par excellence, of transference relationships. The group can come to represent, in the minds of its members, the community as a whole or social conscience, and an individual will feel ashamed, embarrassed or rejected if the group judges him. Not only can the conductor in his person come to represent these things but the whole group can do so. Furthermore the conductor and the group can also come to represent the objects of what is called object relationship in the mature macrosphere, for example husbands, wives

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and friends. Their feelings towards such people, or rather towards their inner images of such people, can be projected into the group. At one moment the conductor may be seen as an almost god-like idealized parent, at another as a bad parent who is feared and rejected, or the ‘group as a whole’ can be treated as a mother, or individuals in the group can react to one another in terms of transference in a stricter sense as if to their sisters, brothers, mothers, husbands or wives. (Foulkes and Anthony 1984, p.249)

According to my experience in different spheres of therapeutic work I tend to see the transference constellations becoming manifest in different ways with each type of work. Three general examples are presented in Table 5.1. As seen in Table 5.1, the job of the group analytic art therapist is, in some cases, more complex than that of the verbal group analysis therapist. These magical and mythical connotations often stem from the primitive as well as the earliest days of infancy and childhood. Regression is often powerful and, at times, immediate.

Table 5.1 Types of therapy transference constellation Individual psychoanalytical psychotherapy

This shows itself mainly as a parental structure initially. It may move to other superego figures, e.g. teachers, employers. It will include lovers and enemies.

Group analytic psychotherapy

Here, there is a multiplicity of transference constellations between all members. All of the previous characteristics are in operation, but added to this one finds extended-family figures, e.g. grandparents, uncles, aunts, cousins. The symbolic transferences are more in evidence, e.g. the great mother, the lost family one never had, the avenger waiting to seek vengeance.

Group analytic art therapy, individual (insight-oriented) art therapy

The transference constellations as seen in the above are also present here. The extra transference dimension would extend to the magical and the mythical. Although these are present in group verbal analysis, they become more visually evident in group analytic art therapy. Therefore, it is sometimes difficult to maintain the position of the verbal group analyst, based on the power of the projections, e.g. when seen as the wizard, any attempt to step down to Earth by the therapist is seen as wizardry – a very good trick if successful.


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The ‘individual in the group’ analytic art group is not only a conceptual fragment of the whole group but an integral part of a dynamic system in which the individual has his own separate space in the first section of the session to make (or not make) his own concrete marks. Even by not making concrete imagery, he has still made his mark, as the abstinence is seen clearly with the empty page. Considering the primitive roots and sources of transference in the art group, I have been seen as a magician, a godfather, a midwife, a grandfather, a leprechaun, the devil, various animals, a priest and an honorary woman, to name but a few. With this extended transference discussion, I have made a digression into what would appear a lengthy discourse and, possibly, somewhat of a red herring away from the ‘individual in the group’. Basically, I believe that we have kept the individual in our sights throughout the transference dialogue. With individual therapy, the person may be removed from his natural and extended groupings in the course of therapy and as a consequence of his condition. In contrast to individual therapy, where there is no direct group involvement or exploration, the individual within the group is open to a new group system. This is immediate in its impact. Although in individual therapy the client explores his original groups, it is in the group that the individual actively explores these groupings in a new way (Foulkes 1964, p.75). It is here, through the multiplicity of transference struggles and relationships, that the individual finds his solutions and, through being a group animal once again, is restored to a greater state of individuality. Dependence and independence no longer fight over sacred individuality or group consumption of the individual and are replaced by interdependence between individual and group. This maturing concept of interdependence can help us to comprehend the situation when it is suggested that an individual is speaking for the group by being the most prominent person verbally. This term is an abstraction based on the premise that an individual epitomizes a particular dynamic at a particular time, for example, the silent minority, the opposing leader, the salient and hidden truth, the risk-taker, the joker, the voice of sadness or the ‘wish I could say that’. By being the voice of the group, one is no less an ‘individual in the group’. The merits of this may well be an increase of individuality elsewhere, with a growing sense of self. On the other hand, the individual who maintains the predominantly silent position (but not intransigent silences for long periods of weeks and months) is no less an ‘individual in the group’ just because the amount of words ushering from his lips or the concrete imagery tumbling from his paintbrush are not as

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voluminous as those of others. Group analysis permits all members to be individuals in their own right and, thereby, carve out their own space in accordance with others. The more the individual feels an acceptance (not coercion) of himself in presenting his true self, the more cohesive will be the group as a whole. Through such interrelationships in the group, the individual cannot be void of becoming part of and projecting transference constellations. No longer is transference strictly the domain of the analyst and analysand or, indeed, those group therapies that maintain a psychoanalytic methodology. The transference field is much more extensive and exciting.

The new group: a group of individuals With the established group, which I will proceed to call the mature group, a culture has developed that has been shaped by its history and continuity and that forms the ‘group as a whole’. In the mature group, there is not the same battle between individuality and group culture as occurred in its formative days, although at times of conflict or the entry of new members, the old battles may be resurrected. The entry of a new member into a mature group does not necessarily play individual against group but may be more aligned to old and new dynamics. In this instance, there is a threat to the security or cosiness of the group. Such struggles may be equated with the birth of a new child. A paradox may exist here, in that the new member experiences an intense and heightened vulnerability, with a fear of the group. This is opposed to the joy that could be experienced in the group (family) were it not for the jealousy and envy of the ‘newborn’s’ special position. With this magnified position, the newborn individual is stranded in limbo between his (vulnerable) world and that which is without in the group. The special place of the newborn member in the ‘group as a whole’ highlights just where other members are placed on the therapeutic continuum towards leaving. On further exploration, a conflict will be revealed between the new individual’s feelings of powerlessness with a fear of annihilation, while the ‘group as a whole’ projects powerful dynamics of jealousy, envy, rivalry, protection and concern. In this paradoxical position, existing members feel as individuals while expressing the collective state of the group. However, there is one variation where the apparent split between the individual and the ‘group as a whole’ is different – the newly formed group. In this situation, no group culture has been established yet and each individual’s position is distinct and separate. The group ideology at this point is a figment of something yet to emerge. Abstract statements about the group ‘thinking’, ‘feeling’ or ‘experi-


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encing’ are of little consequence at this point. Returning to the birth analogy, it is rather like having a multiple birth and trying to treat it as an immediate single family rather than getting to know each baby in his or her own right. Basically, the ‘groupishness’ will emerge in its own time given the right circumstances. The individual in this first session is one of a larger number of people (six to ten), all clamouring to find the nipple in the dark. An animistic example may be more appropriate than human, as the dog, pig or whatever has enough nipples to accommodate the multiple birth, unlike the human mother. Excitement and fear are two sides of the same coin here. The new-person position is magnified ten-fold, with each individual entering with his own particularities. Compared with entering a mature group, the new person cannot enter as gently in the new group. He may not have the luxury of staying in the side wings until he is ready to step on stage. Each individual is highlighted by that which he brings. The currency of his isolation or wretchedness outside is now the currency of all who are within the group. As yet, no member has reached that distant point in group culture parlance of being ‘the most together’. Now, in the setting of the new group, individuals are faced with a universal dilemma: ‘I felt I was the only one in the world who felt and acted in this way!’ ‘How can I really help anyone?’ ‘How can any of us help each other?’ ‘It would be like the blind leading the blind!’ A possible truth in this last comment is that a blind person may do better at leading another blind person, as he has been to places that a sighted person has not. Individuals are afraid of mixing in case they infect others or are infected by others. However, by each new member ventilating such individually isolating experiences, this forms the blueprint for the analytic group. Like the blind leading the blind (in their uncertainty), out of the initial darkness the group is found. This moves the individual from symptom formation in the groups’ early stages towards collective meaning. All of these dynamics and group processes are seen clearly in new group analytic groups, be they art or primarily verbal.

The new member entering an existing group I now turn my attention briefly to the individual entering a mature group. To illustrate this process, I will create another fictitious art group, describing it from the client’s perspective. For brevity’s sake, I focus primarily on the first part of the art group, that is, the image-making. The individual would have been assessed by me prior to joining the group.

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The session Sean is early and the first one to enter the art room. I show him to the art-making tables and tell him that he can do what he wants and that the others will come soon. I say that we will be talking about the finished artwork later, approximately halfway through the session. Sean (thinks): It's tough getting here. I’m shitting myself. What have I let myself in for, especially as I can’t draw or paint? Gerry said it might help to communicate what I’m going through; being with others also might help. He said other things [at the assessment interview], but I can’t remember. I don’t know whether I want to share anyway. I could have stayed in bed all day; I hardly slept last night. I’m still trembling. I wonder what’s going to happen? How on Earth can this help? I can’t think what to do. Gerry said that when I came into the room the others would be here – where are they? How many did he say there were? He told me to look around the room and when I felt ready I could do whatever I wanted – I feel like running out, but I’m sure he meant paint, draw or something. God, this rooms feels like me – a mess! There’s still no-one here yet! My mouth’s dry. Sean: Gerry:

Gerry, can I have a drink? Yes, you know where the sink is. The glasses are there; help yourself. Sean: Thanks. (Goes to the sink). Sean (thinks): I had hoped I could go out to get the water. There are some brushes, paints, paper. Oh well, here goes! (He picks up some paints, his glass of water to drink and goes back to the table he sat down at when he came in, setting his stuff down.) What’s Gerry doing just sitting there? I wish he’d bloody well tell me what to do. Oh God, other people are coming in – two, three together. [Sean’s head’s down.] Would you believe it? They’re talking together – something about the traffic and getting here. Others are coming – even laughing at something.


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Someone asks my name: I mumble it, and again to others. They tell me theirs, but I don’t recall any. Sean: Pardon? Oh, yes, I have everything I need thanks. Sean (thinks): They turn away and carry on talking. Gerry get me out of this! You talked me into it. You’re still there, just watching us. I look at the paper. Oh, I hadn’t realized I’d made a mark; gradually I’m making more. What’s this? Lots of colour thrown together. I cover it with black and more bright colours. What’s this? A fence – a woman’s face. I look up: everyone’s painting and drawing. Gerry’s missing; he’s not in his chair [panic]. Oh! There he is, standing between two people across from me. He makes a few remarks, which I can’t hear, and moves back to his chair. Bastard! What’s he doing that for? I go back to painting. I haven’t a clue what this is all about. Everyone else seems to know what they’re doing. It doesn’t look like there’s much wrong with people here. Wait a minute! That woman (was it Zeta?) – she looks quite down. She hasn’t painted anything, but she’s crying silently. The tears are falling on the paper. I didn’t think people could just not paint; someone should do something. I can’t do anything. I start painting again. It looks a bit crazy – I’ll put in some mountains and a sky in the background. As I finish this bit off, everyone gets up and goes to the other part of the room, where there is a circle of chairs. One of the women asks me to come over when I finish, but I get up immediately and follow her.

Open group dialogue Mary says: ‘Why don’t you bring your picture over, Sean?’ I go back and get it. I’d wanted to leave it there, but I had better not. I put it beside my chair in the circle. Everyone else has theirs in front of them. I look at the clock and am surprised that 55 minutes have passed. It all feels a bit close, so I push back

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my chair a little, but no-one seems to mind. I look on as everyone begins to talk freely about their pictures. Moving away from the focus on Sean in this fictitious session, let me present a more generalized view on the outcome of the session. By and large, Sean would be left to enter in his own good time, either speaking or not about his picture. Mary had asked him to bring his picture into the circle, which he complied with, but he was free to not do so. If there were pressing or ongoing issues in the group, Sean may have been left aside while the group proceeded with its business. If the group was fragile, he may have been thrown more to the fore as a welcome newcomer or even a saviour. His picture may have been acknowledged more directly, and this may have been a way in which the group encouraged him to speak of himself, offering supportive statements on the initial difficulties everyone had in putting brush to paper in their first session.

Conclusion I trust that the fictitious illustrations cited in this chapter give the reader a feeling of what happens for individuals in art groups conducted along group analytic lines. In the remainder of this book, I present further fictitious and real sessions in order to expand on the theoretical points elaborated. As I stated earlier, I have included a discussion of transference constellations for two reasons. First, I have attempted to promote thinking on a conceptualized whole of transference and counter-transference. Second, I have tried to show that transference constellations emerge as outcomes of individuals’ experiences within a relationship/group context, although particular manifestations can be described more from the ‘group as a whole’. These, I believe, cannot be seen as separate group entities. I would be in agreement with Schaverien on the embodiment of imagery, but I would not agree on concepts such as transference within a transference or that the image can become an object of transference in a similar way as people do. However, one could argue that individuals project on to and create the ‘group as a whole’, like making a picture. This is so, but a difference is that one cannot control and make others malleable as one can with an individual picture. There is certainly much more that can be said about the ‘individual in the group’, but for the time being I will move on.

Chapter 6

Transitions

Introduction On the night of completing the first draft of the previous chapter, I struggled to get to sleep, because the ideas for the next chapter kept coming. I attempted to force a transition from wakefulness to sleep, but the more I forced, the harder it was to sleep. This reminded me of previous transitions in both my life and my therapeutic career, which, on the whole, did not happen consciously and seemed rather accidental. There was always something within particular events that seemed to shape these transitions. These, I believe, were built on environmental demands and unconscious drives. One simple illustration was when I wrote my qualifying paper for the Institute of Group Analysis on confusion and fusion (McNeilly, unpublished work, 1987). At that point, I had reached a peak of despair, not knowing what to write, and a period of confusion ensued. Then I had it: I was confused and this brought a conclusion. The transition moved me from trying to be objective in my theoretical strivings to giving myself up to a transitional process of confusion towards fusion. A transition may be defined as a sequence of movement from one point to another of things, ideas or life events, which are in constant flux. This may be assumed to be progressive in nature, i.e. anal ® oral, stages but equally it may be regressive. It may also be seen in the process of internalizing new interpretive comments or simply the basic need for people to return to their home countries as a stimulus for future life. Each of these steps back may be part of a transitional process. With transitional processes, the starting and finishing points are difficult to define. In an analytic group, when questioning individuals/groups on why there were specific points of change, they find it difficult to answer. A patient in a group of mine once said: ‘Thinking about it, I’ve forgotten what brought me here!’ Equally, in art therapy, if a set of concrete images denoting change takes shape, the same questions arise.

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Transitions can be extremely subtle in their emerging points and difficult to hold on to – rather like slippery fish. I have called this chapter ‘Transitions’ in an attempt to encapsulate the various changes I have made over the years, although I have already spoken about some of these in Chapters 1 and 3. Regarding Winnicott’s transitional phenomenon with its objects and space, I have found his writing in this area helpful in my own descriptions of transitional space. With the first strokes of the brush in art and art therapy, the execution of the act appears simple. However, a great deal of unconscious/unspoken internal dialogue may ensue before the concrete touch of brush on paper. With the first words spoken in life and the gradual sophistication of using language to convey feeling/meaning, it is difficult to gauge a transition from simplicity to complexity. With both concrete art and language, transitional processes oscillate between simplicity and complexity. Consider the impact of a child’s first word, the conjunction of a tear with either happiness or sadness, the child’s first drawings, the power of ‘I love you’. In Chapter 1, I stated how important groups were to me in my early life. However, analytic perspectives on transition were not open to me then. Certainly, my beginning in music groups taught me much about improvisation, which I feel has assisted me in the use of interpretation. By this, I mean that when endeavouring to interpret in therapy, the words one uses cannot be exactly what is within one’s thinking at a given time. The thought preceding the interpretation is a mental floating thing. This changes in many subtle ways the moment it takes form out of the therapist’s mouth. On one level, it moves from the therapist’s internal world to it forming a link and a live relationship between two or more people. Although the validity of the interpretation rests on the patient’s/group’s internal/external realities, it is also dependent on the therapist’s creative application of his art as a communicator. Just as good interpretation is based on theoretical and empirical knowledge, so improvisation is based on sound musical rudiments. My own early musical attempts at improvisation disguised little concrete knowledge. This early musical example can also be applied to my early days as a therapist when my mouth would work before my thoughts and emotions were ready.

Early professional transitions Before starting my nursing training, I was working in a furniture shop in the day and playing in a musical group in the evenings. I was getting nowhere fast and I had no professional aspirations. There followed a six-year period

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progressing through many menial jobs and failed attempts at training. I was not ready for any of this, as the discipline involved was like an enemy. Once I started my nursing training a strong student group formed, which spearheaded many innovative projects, while challenging hospital hierarchy/authority. My creative and artistic side and a developing leaning to leadership emerged. This was a time of great turmoil, but I believe that the creative part of me held the fulcrum. Then, in my last year of training, a beacon of light shone through, which was to change my life completely. A new art-therapy department was opened in the hospital where I worked. Bruce Males was the art therapist who started the department and who first sparked my interest, unconsciously at the time. The art-therapy seeds were sown without my conscious knowledge. When I finished my nursing training, I chased my musical and artistic dreams to an isolated mountain cottage in Ireland, not giving nursing or art therapy a second thought. In transitionary terms, there was a regressive tendency to get inside myself as well as into the womb of hibernation in the Irish mountains. Once again, fate was taking a hand, and eventually I was offered a nursing position in Ireland. I had spent about four months satisfying my dreams, but then the reality of living conditions and hunger hit me, so I accepted the job. This offer had resulted after I voluntarily painted some murals for the children at the hospital; the nursing position offered me an opportunity to develop my artistic side in a form of occupational therapy. As well as beginning to be respected for the innovative work I was developing with people who were learning-disabled, the fact that I was the only male nurse had its benefits. I felt needed and cared for by my female colleagues and was getting a feeling of being mothered after my mountain isolation. The fact that this work was to last nine months may also be significant – a period of gestation. Eventually, the art-therapy seed that had been sown germinated. I had reached a point in my work at the hospital where my intuitive and previously innovative moves were becoming stuck and repetitive. At that point, I had no idea of what a therapeutic training would entail but I had recognized that my art therapist friend Bruce Males was doing something that attracted me, although I didn’t know why, and I started my art therapy training in St Alban’s, England.

The melting pot When I was accepted on to this training course, the excitement was immense. My symbolic mother, Foyle Hospital colleagues, applauded me. I was now to

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be a real student. My working-class roots rebelled at this, but my envy was satisfied. This now opened up a part of me that had been closed from my days at school in the art class. Until then, I had never acknowledged unconscious areas or even the fact that I had an unconscious. Moving briefly to the present, I feel that my theoretical exploration of opposing forces and polar balances has its analytic transitional roots in these early art therapy training experiences. On reflection, I felt I was moving on a fairly primitive level from one extreme experience to another, while trying to maintain levels of stability and understanding in such processes. At the time of writing, it is now almost 30 years since I started training and I find it difficult to conceptualize how it worked for me. However, I am convinced that the analytic melting pot became operative during that art therapy training course. I would like to mention a few points of development within this period that mark these transitions. I really did not know what I was letting myself into with such training, but I had a general feeling of being opened up on many levels. I was in the presence of so many students and teachers from various walks of life. I began to feel special, and I immersed myself in all that was happening around me. The world of people speaking openly about feelings had been alien to me until then. Teachers, to me, were like a red rag to a bull, and although I still had a tendency to fight authority, this was something new. There was a fostering of equality between teachers and students. I recall doing my first oil painting, collecting rubbish for a sculpture, making batiks and my first art exhibition. Probably the most important starting point of the transitional process was the experiential training groups. These were my first experiences of anything remotely resembling psychotherapy. The as-if-I-was-a-patient side of me became dominant. This was not surprising, as the deeper parts of me were now strongly in transit. There were three particular learning formats: experiential verbal groups, art therapy groups and psychodrama. The overall transitions within these groups were powerfully stimulating and, at times, overpowering. For the first time, I really experienced the power of transference. I have termed this overall training experience the ‘melting pot’ as many basic thoughts, feelings and experiences were thrown into the pot. However, this was the first stage of a series to be developed in subsequent years. I reached my art therapy graduation day on 8 July 1976; some years later, I learned that on the day I qualified, Foulkes died. He was leaving the world

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and I was entering a new profession, which eventually would lead to this book. After completing my art-therapy training, I once again toyed with the idea of returning to music, this time to play in Germany. By chance, I visited the therapeutic community I spoke of in Chapter 3. Possibly this was a synchronistic position, i.e. they needed an art therapist and I was there at the time. One thing that was important within these transitions was the dynamic of being at the right place at the right time. So, as I now started my new work position, I had to develop an arttherapy system, which I spoke about in Chapter 3. Recalling these starting points, I was almost thankful to my father for throwing me as a young child into the river and giving me the choice of sinking or swimming. Throughout my decade at the therapeutic community, the transitions took various forms and shapes, which I will expand upon later. My arrogance and feeling of omnipotence played a part in these early transitions, but at the same time I was striving towards a more integrated model. Art therapy as a stand-alone technique would not help. The transitional continuum of what I had learned at college had equipped me to a point, but in the real world I was now floundering. My rites of passage had moved me through college and into the workforce, but the transition of such intensity had only just begun. I now had to deal with patients’ transitions through me as the art therapist, and I was on the end of transference projections. I started like any new art therapist, believing that red or yellow means this or that and putting these colours in the same picture will mean such and such, etc. When a frightening picture was expressed, I would, at times, see it as an alarming sign and warn the other staff about suicidal potential or self-damage. Particular shapes and symbols were unconscious openings. I almost felt like Freud’s scout. When black paintings were produced, I would be concerned that it was evidence of depression, and thought that if I used a few techniques I could promote some new ‘antidepressant colour’ to counteract the depressive decline. I recall using paradoxical injunctions through interpretation, which only added to the desperation of the patient/group. At other times, I thrived on confrontation. There were particular meanings and symbols for schizoid, paranoid and obsessional pictures. I had learned the basic rudiments, but on only one scale. Much of what I had learned was insufficient, rigid and restrictive. In my transition from student to professional, the part that had assisted me most had been the opportunity to ‘be the patient’ in the experiential groups. I had learned to tolerate silence and chaos

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more easily, but I was forgetting these lessons. Theoretically, things weren’t much better. My initial training was a drop in the ocean. Building on the points I raised in Chapters 2 and 3, in my first one or two post-training years, I began to develop parallel lines of work: outpatient art therapy (individual), individual verbal psychotherapy, outpatient art therapy groups and my training group as a student group analyst. As my individual outpatient art therapy work developed, I was able to use theoretical perspectives I had learned at college. Once again, however, ideal theory and practical application towards developing technique were not easy to achieve. My struggles during these early transitions were manifold. One of the difficulties within therapeutic communities is that at times, many things are happening concurrently and tax emotional experience and intellectual comprehension. Hence, this may restrict smooth and curative transitions for its members. One of the difficulties with the transition of art therapy into a group setting in those early days was linked to the varying ideologies and techniques that group leaders had (see Chapter 3). One agreed perspective between all of these practitioners was the influence of parental dynamics being replayed with the transference constellations. Although I agree that this was so, I felt it amiss to adopt wholesale methodology that was applied to outpatient individual therapy. The understanding and practising in therapeutic community groups calls for so much more. Therefore, in my creating and establishing the art groups, this often jarred with the ongoing ethos of the small verbal groups within the community. With the transitionary processes over the decade of my work with these community art groups, I developed a counter-position (‘group as a whole’, symbolic, societal) to the singular parental perspective, that is, primarily staff and patients would conceptualize interaction between staff and patients on father, mother and child equations. As a synopsis of my counter-position, there are particular questions and principles that go beyond the parental framework. ·

What does the concrete imagery produced by the individual say about him, his group and the whole community?

·

How does all of this reflect external life situations and society in general?

Each of the points I raised with my originally naive questions and assumptions have been explored on different levels within the ‘group as a whole’. These have been covered in hundreds of art group sessions, and it has been a slow transition. On reflection, my early theoretical frames of reference were

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attempts to find and trap meaning, validating my acquisition of the job in the community in the first place. As the establishment of the art-therapy system in the community became more accepted and refined, a sequence developed. The concrete images directly or indirectly reflected each day of the community’s life. A general pattern in the art groups emerged. Monday: This often reflected the problems patients had when they were at home for the weekend. Patients focused more on their own family life beyond the community and the difficulties or relief about returning. (Most patients stayed at the community five days per week.) Tuesday: No art group. Wednesday: The art group occurred after the large community psychodrama in the morning. Often, there would be leftover feelings from this, so we experienced delayed ventilating, progression of psychodrama themes being made concrete, and resolution of leftover psychodrama issues. Thursday: Community issues would have progressed markedly through the week and often would emerge strongly in this group. On Wednesday evenings, there was often a community social event, and some of this would filter through in one form or another. Although acting out (physical aggression, self-damage, sexual relationships between patients, substance misuse) could happen at any time, the Thursday and Friday groups brought images about such areas. Friday: The imagery took up a number of strands here. Pictures were created about being away for the coming weekend. Leftover issues from the week often were portrayed as strong destructive images or expressions of success, almost as if the patients were leaving that part of themselves in safekeeping over the weekend. Also, as the community case conference (review of patients’ treatment) for patients was on Fridays, the art group was central in preparing for this. Friday tended to be ‘leaving day’ for people finishing therapy, so the art-group imagery also reflected points of closure. ‘Group as a whole’ imagery portrayed that patients had spent another week together, and some imagery also reflected not opening too much up because of the coming weekend and points of closure.

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The analytic transition of these art groups was to develop into a more central or core position. Eventually, this helped people to make more sense not only of art therapy groups but also of art within the overall system. Until then, there was almost a taboo in developing links from the small groups outwards. I felt, therefore, that the art groups became a pivotal focus for the whole community. This was evidenced in the art group’s symbolism and abstractions becoming visual, which then enhanced language. During the decade of this development, there were many variations; my bridging attempts were seen as breaking existing small verbal group confidentiality, which was also seen as an unnecessary secrecy. This eventually led to a welcome acceptance, but not with everyone. Eventually, the overall group culture became stronger, and other staff members began to train in group analysis. This then fed back into the art groups, and I was less alone with theory and practice. In my final year at the community, the group analytic art therapy approach had become solidly established and more sophisticated.

Other transitional avenues So far, I have focused on the specific transitions that revolved around the integration of art therapy within the community. There were other developments outside the community. Two of these were my group analytic training and becoming part of the training group of the Association of Therapeutic Communities. With this former venture, I was part of the training group for ten years. One of the main elements for me was that I was beginning to develop my group analytic art therapy model within professional groups. This training/ teaching transition was developed further in Goldsmith’s art therapy training courses at the University of London, where I became a staff member. In this setting, I was able to hone the theory and practice. Throughout this process, I addressed core elements in all art groups (patient or student), learned to see that which is specific to different settings, and, finally, developed a combination of one-off art-therapy workshops (a term for experiential groups), seminars, lectures and supervision. I was also beginning to write and publish theoretical papers. The combination of all of these clinical and academic involvements could be described as a system of transition. Let me expand a little on my group analytic training. The amalgamation of all parts of the training assisted my transitions. Over these years, I was searching for new and parallel points between verbal

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and art groups. My attraction to the Foulkesian model began in the introductory group work course that I attended between finishing my art therapy training and beginning my formal group analytic training. The small group I was a member of on the introductory course, which was conducted along group analytic lines, was different from my art therapy training group (verbal), which was structured on a Bionic model. In the new setting, I felt safer, as there was more sharing and cohesiveness. Also, with the move into concrete theory I was beginning to conceptualize more of what previously my intuition had been telling me. This brought more discipline to the process of learning. Increasingly, I saw that the process of exploring deeper parts of myself, along with group interaction, was an essential adjunct to the academic parts of my training. Over the years, in my twice-weekly training group, many of my earlier transitional conflicts became clear and resolved. I recall key points of conflict and insight and fond memories of my fellow group members. It is probably here that I learned to hold on to feelings from deep inside and to analyse these and compare with earlier intellectual interpretations. My own group analysis has probably been the most crucial component in the transitional process between my personality and my art as a therapist.

Specific technical transitions Before I focus on specific areas, I would like to say that in acquiring more discipline in theory and practice, I have also become more flexible and relaxed. If, for example, I want to laugh or cry with a patient, I am not so worried whether this is technically right or wrong. I recall one patient who, after a long period in therapy, cried deeply about her pregnancy miscarriages. The pain and sadness was so intense that I also cried. When the time was ready for later understanding of this, she felt that my crying gave her a sense of security, because I was ‘giving her permission’ to cry. This was in opposition to her mother and father rejecting her emotions, telling her to pull herself together. The specific technical points of transition have also been framed within increasing areas of professional responsibility. I had developed my craft as an art therapist while developing as a group analyst. I had also gained positions in the art-therapy academic section. I then moved on to directing a counselling and psychotherapy service. These frameworks facilitated further technical transitions.

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Individual art therapy Although my days of working with individuals in art therapy are long gone, I feel that my overall transition was influenced by this work. My group analytic work has also been influenced by this, and for this reason I am including it in this book. Possibly one of the aspects that made the outcome of my art therapy with individuals less hopeful was that I was asked to work with people who were considered difficult to work with verbally. These people were very emotionally damaged and found it difficult to speak and communicate. Experienced therapists would find such people difficult to work with, but I was young and new to the trade. In some ways, I naively conveyed a message to my colleagues that individual art therapy would reach the parts others could not. I imagined that art could make up for the absence of language in this contextual framework, but I did not account for limited or no motivation. I was blindly trying to instil hope via my own omnipotence and motivation. As individual art therapy took place within an outpatient section of the therapeutic community, I was often asked to consider people who did not match the criteria for acceptance into the community. Such people were too schizoid, or would find the community too stressful, or were not yet ready for admission. I was, on occasions, considered the last resort. At times, I thought that other staff members saw individual art therapy like a can opener on a bent can. This could be seen as a false promise of hope or forced entry to make the technique work. Generally speaking, outcomes were questionable but not catastrophic, although there were some positive outcomes. Failure of the method was ascribed to reasons for selection in the first place. There were also blind spots during the art therapy sessions. A primary point was my early evasion of transference constellations. The technical structure was quite simple, which was similar to my developing group analytic model. When the patient came into the room, he or she was expected to make a picture or sculpture; we would speak about it when it was completed. As with the structure of the art group, approximately half the session time was devoted to creating imagery and half to talking. My evasion of transference constellations was concerned with maintaining the focus between the patient and his artwork. Seldom was I brave enough to look at what was happening between the patient and myself, even when I was aware of it. When I did work openly within the transference, I was often hesitant in my formulations. Of course, as I pointed out earlier, some of the patients’ limited or absent motivation may have contributed to my evasions.

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One cannot turn back the clock in order to undo technical errors. However, one can speculate about how things could have been different. For example, did I influence a woman who, in the early weeks of her therapy, telephoned to cancel her session as she was getting married on that day? Would she have got divorced the week after she finished therapy (a two-year period) had I worked more with the transference? I recall a man I saw for individual art therapy who had witnessed a friend drown. Rarely did I notice or speak about the transference, and many of this patient’s concrete images depicted the traumatic scene. He himself almost died in the accident. I saw this man for two years. At our last session, he almost fainted as he left the art room. Would this have happened had I worked differently within the transference? Was this fainting a re-enactment of his own passing out while witnessing his friend’s death as I died therapeutically? Bearing in mind the focus of transition, I cannot say how my individual art therapy evolved over five years. Although I have written little about this, I feel it to have been an important part of transition – if only to show that my interests lay elsewhere.

Art groups to group analytic art groups In earlier chapters, I gave a more detailed theoretical account. Now I would like to focus on a transitionary process from a historical perspective. Whereas my individual art therapy process stopped, the group transition continued. The transitionary channels ebbed and flowed according to many elements peculiar to groups and settings. Unlike my individual art therapy, I was increasingly able to make use of transference constellations within groups. The focus moved gradually from each individual’s imagery being seen as singular entities (expressions) to seeing them as individually significant expressions within the group matrix or life of the group. On the whole, the focus on the imagery over the years became more important. I was less trapped by an old ideology that dealt mechanically with each individual’s image, almost as if they had been projected and separated from their creators. My developing ability as a group analyst assisted me to be more convinced that the model I was developing of group analytic art therapy was a serious venture. Likewise, this model helped in my work with primarily verbal groups. In conclusion, it has been my intention to map out a series of chronological progressions. Because of the vastness and complexities involved, I have had to limit this to brief accounts of how things were in the past and associa-

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tions with the present. I hope that I have expanded upon Chapter 3 in how I introduced art therapy to the therapeutic community, using it as a pivotal point or an agent for creating meaningful links. These were attempts at joining individual expressions to small groups-as-a-whole conceptions, small group to large (community) group, large group to society, and vice versa. With these transitionary processes, there have been progressive and regressive elements. Also, there have been the contributions of my external interests while working in the therapeutic community. Just as these early developments created powerful and active impacts within the therapeutic community, and the art therapy profession in general, my later group analytic model was to gain relative prominence. These are important links in the chain.

Part Two

The Portuguese papers – new developments As I stated at the beginning of this book, I began my contact with colleagues in Portugal in 1997, which opened up new developments. I shall develop here ideas that were initially formulated as a result of my contact with Dr Carvalho. In Chapter 8, I elaborate on the papers that I presented during these years on resonance and intuition; complexity, simplicity and subtlety; and psychotic openings. Although I presented each subject at different times, the topics are linked, in particular in the dynamics of movement on a deep unconscious plane, along with the ways in which such movement finds openings into consciousness and group interaction. Chapters 9 to 11 cover in more detail the perspectives of the ‘individual and the group as a whole’. The section on dualities reconsiders some of the points raised in Chapter 8 but adds new dimensions. Although I have already spoken extensively about Foulkes’ views on the ‘matrix’, I shall develop this further, by bringing Foulkes’ views together with Cortesão’s theories on the pattern and adding my own theories on the ‘fullness of emptiness’.

Chapter 7

Introduction: literature review and developments since 1990

In the earlier parts of this book, I wrote about historical factors with the development of particular theory and practice. Until now, it has been difficult to gauge where to include a literature review. One can see an emergent theme of binding together and pulling apart with our historical, theoretical and technical evolution. The following historical account should help us to pull things together and to give a firmer grounding for the new developments that I will postulate in Chapter 9. Compared with that for individual art therapy, the literature in the group field is deficient. There is only one art therapy journal in the UK, Inscape, and this has published little on group art therapy. However, various articles have presented theory and practice elements about individuals within the context of a group. In the USA there are a number of art therapy journals, but I am disappointed that the individual perspective far outweighed the group focus. Returning to Britain, I’m aware of only two books that address groups specifically from a psychotherapeutic perspective: Group Interactive Therapy (Waller 1993) and Art Psychotherapy Groups (Skaife and Huet 1998), which covers a wide range of clinical settings from a number of British art therapists. I am thankful to these authors for giving attention to my own group analytic art therapy publications at the time. An earlier book, Art Therapy for Groups (Liebman 1986) described itself as a ‘handbook of themes, games and exercises’ and so was not particularly psychotherapy-oriented. In a book I edited with my friend and colleague Andrea Gilroy, art groups were given attention (Gilroy and McNeilly 2000). Reading an annotated bibliography (Hanes 1982), I was pleasantly surprised to see that the USA had produced a body of art group literature, but not many considered psychotherapy groups. I noted that in that book

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there was only one reference to Foulkes (McNeilly 1986, pp.282–3). The book annotates 30 years of literature, with 538 reference points. In respect of the literature today, I do not know whether the US art-group models are flourishing. However, I was able to locate some interesting articles, which I will expand upon shortly. I did not explore art groups on a worldwide search, so there may be thriving art-group psychotherapy approaches in other corners of the world. With my review, I have narrowed down my research to art-group literature concerned particularly with a psychotherapeutic framework or intent. I have kept my focus on the adult population, but not psychotic or elderly people. Historically, another factor comes into the equation. In art-therapy training in Britain, students have to be involved in experiential groups for the duration of their studies. They are also expected to set up or facilitate art groups with a very wide range of client groups. So why, therefore, has so little been produced in respect of art therapy groups? I shall present this literature review in a chronological order. The first relevant reference was the account I spoke of at the Northfield Hospital, at which Foulkes was present (1942–45). Potts wrote about the use of art in group psychotherapy and she makes some interesting points: ‘Instead of words symbolic forms constitute a visual language’ (Potts 1956, p.115). As in my own methodology, Potts had separate group sections for creating and talking. Another similar position to my own is that ‘everything that happens in the studio is used for the understanding of the pictures’ (Potts 1956, p.117). Despite the age of this paper, there is a freshness about it. There are early indicators of a directive model (role of the therapist), an early term of ‘projective art’ along with calling patients ‘students’, and an awareness of the importance of the group: ‘The therapist must help each one and the ‘group as a whole’ to feel their way through the discussion lest they be too startled or frightened to produce further projections’ (Potts 1956, p.123). However, the power of the group is not emphasized in this paper. In a similar vein, Azima and colleagues describe analytic group art therapy: ‘Our aim was to allow the patients to use certain media…to create whatever they wished and then to encourage free association to their productions’ (Azima, Crammer-Azima and Wittkower 1957, p.243). In a similar way to Potts, they structured their group with separate, although considerably shorter, time periods for creating and talking. They aligned their method more to individual psychotherapy in uncovering unconscious

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material. Like Potts, they set their focus on the ‘individual in the group’ but also kept the group in mind: ‘Transference phenomena were considered in relation to the therapists, to members of the group, and to the ‘group as a whole’’ (Azima et al., p.253). However, when turning their attention to the whole group, they draw on Ezriel’s common group tension to substantiate the whole group position (Ezriel 1950), which they illustrate clinically. They develop the study of their groups around how the group progresses through various stages in which the image-making becomes more integral (with language), which they describe as an ‘object-centred group process’ (Azima et al., p.257). They emphasize that both free creativity and free association are necessary in their model. In a similar way to a psychoanalytic approach their group met three times a week for a year. I found the papers of Potts and Azima et al. extremely informative, and I wonder why such valuable work seems not to have been developed at the time. Ten years elapsed before other papers relating to groups emerged. Irene Jakab tells us: ‘In group art therapy the benefit of group interaction is used… Soon they may criticize or encourage, by their remarks or attitude, their fellow patients. The therapist’s role is to be the moderator of these interactions’ (Jakab 1966, p.96). This is not so different in group analysis. The work of Bion is built on by Rothhaus and colleagues in their pilot study, which examines three groups using art, with two tasks: ‘1. To decide upon a painting; and 2. To paint that picture as a team’ (Rothhaus, Hanson and Cleveland 1966, p.182). This interesting paper was not intended to portray itself as therapeutic but touched on fundamental issues of group interactional dynamics in line with Bion’s model. In the same year, Vassiliou wrote about his group image therapy. This seemed to promote the production of imagery outside the session. When the artwork was brought to the group, a vote would be taken on whose painting would be focused on. Sessions ran for 90 minutes twice a week. This artwork would then act as a springboard or catalyst for whole-group interaction. The therapist acted in a similar way to a psychoanalytically oriented psychotherapist. Vassiliou noted that, contrary to fears, ‘spontaneity increased in almost all cases’ (Vassiliou 1966, p.411). In 1973, Boenheim regarded art therapy as one of the closest non-verbal therapeutic methods to psychoanalysis, as it brought unconscious forces more directly to the surface. With regard to art psychotherapy groups, Boenheim wrote: ‘They provide special opportunities for the development and understanding of relationships among group members. Verbal exchange

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may be supplemented not only by individual expression in visual form but also by group productions…’ (Boenheim 1973, pp.88–9). Lachman-Chapin spoke of student art therapists. She emphasized the need for more comprehensive training before embarking on work with art groups, with which I agree. She says: and so it becomes important for us not only to train ourselves in group process, but also to examine the use of art in groups. The considerable body of literature now available about theories of group process does not deal with the special aspects of using art in groups. (Lachman-Chapin 1976, p.13) She goes on to speak of a dearth of material on the ‘group as a whole’, but this is not from the point of view of the Foulkesian model. Instead, Lachman-Chapin, like Rothaus et al., follows Bion’s model. In her training workshop her emphasis is on art therapy as a technique aimed at understanding group dynamics. This is a valuable paper, especially for art-therapy educators. Williams, Tamura and Rosen (1977) presented their study of an outpatient art therapy group that met twice weekly for ten months. They wanted to show how art could be useful in enhancing cohesiveness, maintenance of group membership, and individual and group goals. They felt that cohesiveness resulted from the use of the artwork but those groups were task-driven, for example, cutting a large circle of paper into jigsaw-puzzle pieces and getting group members to portray something of importance about each member. This theme is initiated by the leaders and so in essence is a directive model. Their useful term ‘group whole’ does not seem to be connected to a psychotherapeutic construct. The authors speak about utilizing both analytic and supportive techniques. Another aspect of the technique was that the leadership of the group rotated among its members, but it was not clear how this happened. Although the paper presents interesting points on each individual’s position and his progression through the group, my impression of the group’s progression, apart from their claims on the positive effect in their summary, was that it was limited. Rubin and Rosenblum discuss an experiential study on group art. They note that the early years of group art had featured an emphasis on the individual’s art work. They make the interesting statement: ‘While there was often some explicit awareness of the communicative function served by the art work (Sinrod 1964), the notion of more than one individual working


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together on the same product was rarely mentioned or explored as a possible group art procedure’ (Rubin and Rosenblum 1977, p.185). They state that their study is an attempt to look at the relationships between product and process in group art. In a similar vein to that of the previous writers who spoke of looking at the group as a whole, Rubin and Rosenblum did not draw on psychoanalytic or group analytic concepts in this sphere. The main thrust of this paper seems to have been developed as a research project with professional workers rather than patients. Also, the three groups that they studied were given specific tasks – non-verbal chalk drawing, verbal marker mural and individual cellophane representations – and met only once to work together with a follow-up meeting a month later. I do not think that this paper succeeded in its aims, and the authors seemed to be claiming a lot based on little experiential evidence. In a more detailed account, Paulos Kymissis wrote about the use of paintings in analytic group therapy. Kymissis makes use of Vassiliou’s synallactic collective image technique highlighted earlier. Kymissis raises questions on the use of paintings being anti-analytic and whether they can be used to illustrate key psychoanalytic dynamics of the transference constellation and resistance. Kymissis questions this from the perspective of being a group analyst and suggests that ‘it is important for the therapist who uses paintings in his group work to have a clear idea of why he is using this particular technique’ (Kymissis 1977, p.131). In substantiating some of these theoretical questions, Kymissis speaks of patients bringing paintings to please the therapist, another patient or the entire group within the transference dimension. Further, Kymissis speaks of the painting providing obvious clues that can be used for interpretive means by the therapist and the patients. In addressing the paintings used in the ‘group as a whole’, Kymissis at times sees these illustrating the current core conflict; in contrast to an earlier statement about examining things from the group analyst’s perspective, this did not appear as Foulkesian. Kymissis adumbrates a comprehensive list of resistances about bringing paintings, reacting or not reacting, the use of copying and ridiculing others’ work and the method. With regard to the whole-group resistance, it could be seen as an art therapeutic directive when Kymissis suggests that all members do a group painting, i.e. when nobody has brought their individual paintings. This seems to contradict an earlier statement that ‘paintings should not be used to overcome an impasse …to bring some action into the group’ (Kymissis 1977, p.131). Nevertheless, this is an interesting paper.

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Shaun McNiff, who is well-known to the US readership, stated: ‘Group Art Therapy is a process that combines the healing/therapeutic qualities of art with group psychotherapy’ (McNiff 1980, p.34). He goes on to give a short account of various types of art groups and their techniques. He speaks of how the making and sharing of the artwork in the group can take away a great deal of fear that many clients have in discussing their feelings directly (McNiff 1980, pp.34–5). Maralynn Hagood described her work with a group of mothers of sexually abused children. The group had originally been a verbal therapy group, and Hagood saw the adaptation of art as a catalyst. Her method is primarily theme-centred and she gives brief illustrations on the content of sessions related to the themes. As such, this does not say much beyond presenting a snapshot. It also appeared that her way of working was more psychoeducational rather than psychotherapeutic. Although the title concerns group art therapy, I got little sense of a theoretical bedrock beyond ‘art work thus provides a visual experience of issues, and becomes a catalyst for group process’ (Hagood 1991, p.26). Belfiore described an art therapy group experience with nurses and doctors. Like Hagood, Belfiore’s work was theme-centred. Belfiore saw her role more as a storyteller than an art therapist. She cited five objectives for the group: to act as a container in working with hidden and painful aspects; to process mourning; to find verbal and non-verbal methods of working through; to give symbolic form to the group interaction; and to represent ‘a sort of mental space that is able to contain and elaborate the complexity and the richness of the experiences encountered in their daily work’ (Belfiore 1994, p.120). Although I stated that this was a theme-centred art group, Belfiore emphasized that the creative projects were as a result of the needs and dynamics of the group themes and imagery. Although I saw her description of the group’s process in keeping with a directive model, there was a good deal to commend it for achieving its aims. Belfiore also explains the more subtle dynamic elements in the group process. As therapists, we all have to deal with varying levels of stress in our work. Shirley Riley gives attention to this in her paper describing her time with therapists working with severely abused clients. She speaks of using art psychotherapy with this group in order to help them deal with the uninvited shadow of their clients’ ordeals that remains with them and interferes with their own reality. It is valuable for them to externalize and transform this toxic imagery through their own visual products (Riley 1997, p.407). This paper


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described well the value of the group members being able to put into picture form some of the horrific experiences that they individually carried. A systems-centred approach is taken up by Rosen and Mayro (1995) when describing a workshop. This was conducted along the group-as-a whole perspective developed by Agazarian. They looked at the art productions in mural form of four groups. My general impression after reading this paper was that it made some clear statements about how the murals were created and analysed within the Agazarian model. However, their description of the process data and the authors’ interpretations straddled a lot of material that may have been reading more into the meaning of the murals in order to fit the theory. As each mural was created in just 15 minutes, I have doubts about the interpretations of the authors. I am not saying they were wrong, but I feel that the authors’ conclusions were inflated. There also seemed to be a handing-over from the art therapist who led each group to the authors for comparison with the authors’ predictions. This paper is very full and theoretically informative. With regard to their purpose of introducing group therapists to the use of art in group psychotherapy, I would have my reservations: it seems more to do with an art expression being created hastily to be tailored to Agazarian’s group as a whole modality. Sobol and Williams (2001) write about family and group art therapy. In their historical introduction to the group therapy section, although they credit original group theories there is no mention of Foulkes. They state that many art-therapy articles speak about individuals against a background of the group without noting the impact of the group. They highlight the predominance of theme- or task-based art groups in the USA. Although acknowledging Wadeson (1980), who describes some group-process-oriented groups, they also acknowledge the UK process-oriented approaches in Waller’s group interactive, Skaife and Huet’s and my own group analytic models. Sobol and Williams provide an introductory platform for the US readership to the group analytic art therapy position. Shirley Riley’s Group Process Made Visible is a helpful addition to the literature. As space is limited here, I cannot do justice to this book, so I will limit myself to a few brief comments, mainly from Riley herself. In her preface, she says: ‘Groups are a minor miracle…when you add the art expressions to the mix, another mysterious amulet is a part of the process. Now a group has voice, behaviour and eyes! To see forms together and share a vision takes therapeutic intimacy to another level’ (Riley 2001, p.xviii). When she speaks of introducing art as an aid to communication, Riley says:

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‘There is a way to bring a mirror into group that is reflective but not confrontative. A creative modality that can keep the members focused on group activity can bring a sense of urgency by using an unfamiliar form of communication’ (Riley 2001, p.3). This is in keeping with my group analytic model, but my approach is also confronting. Riley speaks lucidly about the interactive group process: ‘The image may also have many meanings…it is there for the group to view and discuss as a concrete feeling; the words are invisible’ (Riley 2001, p.4). When Riley speaks of using the art as a therapeutic tool, she also looks at two ways of exploring imagery in the group: the vertical linear thoughts between the art maker and his work, and the horizontal, that is, the way in which all the members of the group are moving into the drawing. Although Riley’s book is structured in small paragraphs, she packs in a lot of information. Riley does not speak of group analytic influences, but much of what she says in the more psychodynamic sections fits with group analytic perspectives, for example, ‘When the group does not have to be guided by structured directives or suggestions about media, there is no need for the group leader to impose ideas or control the expressions’ (Riley 2001, p.29). Let us turn our attention to a student art perspective. Swan-Foster and colleagues present an interesting paper that would be the envy of a seasoned practitioner. They present us with their account of a 15-week training group as students. They state that the leader’s goals for the group were the students’ personal expression through art and talking, addressing boundaries, and uncovering group conflict and tension. They explore the transpersonal paradigm: ‘Transitions between words and art and between the process and the product’ (Swan-Foster et al. (2001), p.162). There is a contemplative context (the position of group members minding their own process and the process of the ‘group as a whole’), the feminist perspective (a desire to enhance the understanding of a same-gender group), and multicultural issues (accommodating the diversity of their group’s languages, culture, artworks, etc.). They speak openly about their resistances, how as students they were forced together but how the various expressions of resistance led to new group cohesion. They illustrated this in the dilemma of having to or wanting to make art in such a ‘T’ group. In the section on the developmental perspective – what they call the ‘group voice’ – the primary and secondary levels are not dissimilar to Foulkes’ matrix theories. From here, they speak candidly about the group experience, and it would appear that the group leader took a directive approach, getting them to draw their hopes, fears and


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secrets. Giving such an early directive was bound to stir up a lot, possibly prematurely. One may wonder, then, whether this set the scene for further provocation, acting out and resistance. I was impressed by this paper’s clarity and openness. Although the authors do not make any claim to group analytic influences, I feel that much of what they portray has group analytic resonances. However, they do refer to British group art therapists, Waller, Skaife and Huet. Cooper and Milton (2003) describe group art therapy with six self-destructive young women who had problems with substance abuse, eating disorders and self-mutilation. The authors appear to build their work on the theoretical base of ego psychology as well as Winnicott’s formulations on maternal symbolism. They seem to see the role of the art therapist in such a group as providing ego-building techniques. They present a helpful account of various theoretical perspectives on this client group, noting the patients’ struggle with self-destruction and the difficult task of (art) psychotherapeutic intervention. In contrast to verbal therapies, they consider how art productions help to focus, shift and decrease the intensity of emotional energy. In their treatment planning, they took care to create directives for their group sessions to fit into the current context of the setting, for instance, not suggesting a preconceived theme that might miss the dynamic mark. They described their group method as working with individuals in a shared space (similar to playing with toddlers) and not dynamically with the ‘group as a whole’. They also felt that a non-directive method for this group of patients would be less successful for fear of being overwhelmed with rising anxiety. In my own experience, this has not been the case in general with this client group. I do, however, acknowledge that this method would bring containment in that homogeneous environment, but it may likewise promote repressive elements, and the deeper rage and destructiveness may have been diluted rather than resolved. However, saying that, the case illustrations show attempts at channelling such feeling into art activity, which was beneficial in reducing self-destructive activity. This is different from deeper resolution. What also comes across in these illustrations is the belief and care of the therapists, along with how the creative process and the use of diverse media assisted such damaged women. Nevertheless, I wonder whether the authors needed to see themselves as the providers of containment and good enough mothering quite as much as they did in their methodology, as they seemed to carry a lot of projected conscious and unconscious material of the patients.

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British development Until now, I have focused in a chronological manner on a number of publications that have attracted my interest. However, I have not mentioned some of the more recent texts that have emerged from my British colleagues. As stated at the beginning of this review, group art therapy has been the poor relation in British art therapy literature. The early historical illustrations of Irene Champernowne at the Withymead Centre and of Foulkes at the Northfield Hospital experiment are interesting (see Hogan 2001). As I have made reference to my British counterparts in my earlier publications, I shall limit further expansion here. By and large, the writers on the theory of art groups tend to be psychotherapeutic in their approach, although group accounts have been accommodated across the board in British art therapy literature. Although each author, as will be seen, has a particular focus, I believe there has been more convergence than divergence in our presentations. Like myself, two of our leading art therapy theoreticians worked in therapeutic communities and wrote about their experiences. Joy Schaverien, whom I spoke of earlier, worked within a group analytic community and saw art as an integrated aspect of the community. She saw her role as being a guide, creating an atmosphere where a journey of self-discovery could take place. However, Schaverien (1985) does not write about the art group specifically, even though it was within a group analytic milieu. Some years later, in writing about her theories revolving around transference, the talisman, the embodied image and the scapegoat, Schaverien considers how these are evidenced in a group. Although she makes interesting points about groups, she does not build upon this, and it appears to be an extension of individual analytical art therapy on to the group setting. Her description of a short-term group is lucid, and how she sees similar processes in longer-term groups is not dissimilar to group analytic art therapy, e.g. ‘The picture…the most pertinent expression of a group constellation…perhaps the feelings the picture evoked affected some movement…sometimes the picture comes to stand for the role the artist took in the group one particular week… A group myth may develop around a picture…’ (Schaverien 1999, p.151). The full text of this is recommended reading. Possibly, a comparative study of Schaverien’s analytical art psychotherapy with individuals and groups would bear fruit. Another eminent writer is David McLagan, who moved his attention from the therapeutic community to individual art therapy in an eloquent fashion. In his publication about art therapy in the therapeutic community,


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McLagan makes some interesting points. Like Schaverien, he also appears to be addressing more the individual in the setting, while taking account of some institutional elements. He says: ‘Art therapy sessions [groups] are seen as safer and more caring environments’ (McLagan 1985, p.7). In his method, he writes about the group task incorporating making art and talking in a two-part system. Although he states that such groups appear individualistic, he acknowledges that the picture also reflects wider group and community dynamics. Within this article, I did not get the impression that therapeutic use was made of these interrelated dynamics in a purposeful way, beyond acknowledging their presence. McLagan is clearly aware and in tune with the conscious/unconscious messages portrayed through the art groups but it is as if this is transposed back to individual thinking and methodology, e.g. ‘…because of its [art therapy] specialized nature the interpretation is usually left to the art therapist.’ (McLagan 1985, p.8). I presume McLagan meant interpretation of the individual’s imagery and not of group dynamics. From the mid-1980s onwards, other art therapists published their findings. Greenwood and Layton (1987) wrote about an outpatient group of people suffering from psychosis. They made use of themes as starting points for their sessions, but these seemed to emerge from the membership, even though the authors would have preferred not to use themes. Using themes maintained a balance of tension within the anxiety. However, even though the themes seemed to emerge as part of the shared dialogue, it was felt to be the deciding responsibility of one of the authors, Greenwood. Their model of working with this client group appears to be based on Bion’s theories on containment. In a later paper Greenwood and Layton (1991) develop their work with this patient group, in which they expand on the use of humour and satire as a method that developed spontaneously as a way for the members to deal with the enormity of their conditions, not as a defence. As my own experience in the field of psychosis is limited, I feel that I can add little more to this commentary. The first major British book to address group art therapy was Dianne Waller’s Group Interactive Art Therapy (Waller 1993). As colleagues and friends we have worked together and maintained contact for many years. In many ways, our approaches are similar, but there are also differences between our ways of working. Probably one of the baseline differences is that Waller states that her model is based on the concepts of group analysis, interpersonal group psychotherapy, systems theory and art therapy, whereas my main baseline stays

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primarily with group analysis. She incorporates the ideas of Foulkes, Stack-Sullivan, Yalom and Agazarian. Beyond Foulkes and Agazarian, these authors play little part in my theory and practice. Waller’s book was a welcome arrival, and I’m sorry that it has taken me so long to follow up on what she started. Waller has built her model on a wide variety of settings, namely patients, students and groups in other countries, including Bulgaria, Italy and Greece. The first half of her book sets out historical, theoretical and comparative studies, not only from different group-art-therapy approaches but also by rotating the similarities and differences between art and verbal groups. In the second half of her book, Waller highlights specific theoretical headings in brief chapters and illustrates them with a particular client group, for instance boundary violation and scapegoating in a training group. In the first half of her book, Waller takes into account many interesting theoretical elements. In her comparison with Liebmann (1986) and my group analytic approach, Waller veers towards my stance but at different points in the book substantiates the use of themes creatively. She says: ‘When group interaction is combined with image making and the group process takes control, very powerful forces are unleashed. Without the confidence that a thorough training and experience in group dynamics should impart, art therapists are probably wise to try and “keep the lid on”’ (Waller 1993, p.14). Shortly after this, Waller interprets some of my writing as moving towards the interactive pole in emphasizing interactions between members in the here and now (Waller 1993, p.15), but I have always seen the here and now as part of group analysis. Some of Waller’s descriptions of the interactive approach are not dissimilar to those of group analysis, for example, when focusing on patterns of interactions, people’s inner worlds are restructured through interaction. One difference from group analysis is that although much store is placed on change occurring as a result of interaction, it is not considered as the main source or agent of change. In her section on introducing art therapy into psychotherapy groups, Waller provides a comprehensive list of components on a par with Yalom’s curative factors, although they are not direct equivalents. She notes 13 points that parallel Yalom’s curative factors, all of which make interesting reading. A few years earlier, Waller had been the guest editor for the Journal of the Group Analytical Society. The special section of the journal brought


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together a wide variety of creative therapists to write about their work in relation to group analysis. Among others, I and Skaife published in this volume. Art therapists, group analysts and group psychotherapists contributed. Music therapy, psychodrama and eating disorders were explored from the creative and group analytic combinations. Skaife writes about her concept of self-determination, in which she speaks clearly about the structural model she developed (Skaife 1990, pp.237–44). Although she draws from group analytic theory, it came across that Skaife made limited use of group analytic technique. Skaife joined forces with Huet and produced an edited book on art psychotherapy groups (Skaife and Huet 1998). This brought together a number of art therapists, the majority of whom had gone on to train in group analysis or group psychotherapy. This valuable book also covers a wide range of clinical and educational areas. I felt honoured that the editors stated that the book’s intent followed on from my own and Waller’s theoretical positions. In their chapter ‘Dissonance and Harmony’, Skaife and Huet state that a central problem is that there is too much material; by this I assume they mean artwork and language. Following on from Skaife’s earlier publication, they expand on the dynamics inherent in giving space for the group to decide when to start making imagery after the initial verbal dialogue, along with how much time they should then give to communal talking. They equate this process with a musical sonata, formulating a way of thinking about three distinct processes: spontaneous verbal interaction, art-making and analysis of the two. They acknowledge various dilemmas and tensions inherent in their work in the decision-making process within the group in moving through these three phases. I was left wondering about the part they played in promoting such tensions in using the method in the first place. Although this chapter is commendable in its illustration of the group analytic foundation that they are building on, I felt it was narrowed down to a structural exposé and justification of such dynamics as authority and group responsibility. I think Skaife and Huet, as therapists, wanted their group to get into painting as quickly as possible, so why not just ensure that the group paints straight away at the start of the session? The dynamics of decision-making, authority and self-determination will emerge in many other ways. Skaife and Huet’s chapter, beyond the structural concerns, makes many interesting points. For example, when considering both the individual and the whole group, they write:

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However, one person’s contribution to the group process in terms of their image may spark off a substantial amount of verbal group interactive material. So the dilemma is, will the focus stay with the images, or will the images be used as a springboard for further interactive work? There never seems to be time enough for both. (Skaife and Huet 1998, p.28)

My closing impression of their chapter was that within the technique, there was a sense of putting things off, i.e. how long will the patients put off making their first art marks, put off finishing the artwork before reconvening to talk, put off talking in depth in the third phase as they have less time to talk? I hope that these comments will be seen positively, as the chapter is extremely well written and gives a firm impression of their work. Skaife (2000) develops her own ideas further. She argues that the two processes, art-making and talking, have a dialectical relationship. With this in mind, she draws on dialectical theory, which involves conflict and resolution. She states that in group analytic art groups, the image is often seen as a reflection of group processes, and she wants to bring the image more to the fore. She writes: Is art activity in a group about a personal communication between artist and their art work, or is it between artist and group or therapist? This is the age-old paradox in art: do we make art to communicate to others, or for ourselves? The answer, I think, is that both are true simultaneously. They exist paradoxically, or dialectically…so, in the art therapy group there are two processes involved, one private and one public and they exist in dialectical relationship to one another. (Skaife 2000, pp.129–30)

Skaife, I believe, has progressed beyond her earlier work with Huet and into the more complex matter of how art groups function. She has conveyed the intricacies found in a group analytic approach from a number of perspectives with a central pivot of dialectic theory. However, I do not know whether this has built on the structural method of group self-determination in the use of time for making art and talking. Nicholas Sara (1998) examines the dynamics of connection and disconnection in art therapy groups. Although his findings are connected to working with forensic patients in a locked ward, they can be adapted to understanding group analytic art groups across the board. This work is a beautiful addition to the literature, giving substance to the combination of group analysis and


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art therapy groups. A central point of reference is that of the ‘autistic image, which builds on Foulkes’ and Anthony’s theories on the symptom mumbling secretly to itself, hoping to be overheard’ (Foulkes and Anthony 1984, pp.259–60). Sara illustrates theoretically and clinically the different positions of disconnection and connection, both in relation to the image production and in how this moves from the autistic to communicable material. As space is limited, I shall mention only briefly some other publications that I believe add to the body of literature. Neil Springham (1998) highlights the dynamics of resistance for drug- and alcohol-dependent patients. Much of the early part of Springham’s chapter is built upon case conference material, but he goes on to present a clear theoretical foundation. He draws upon psychoanalytical and object-relations theory against a backdrop of group analysis and group-interactive ideas from Yalom. It appears to be the first time that the group in his clinical illustration was together, even though he said all the patients had previous experience in art therapy. I also got the impression that Springham was overconcerned with his own position. The remaining descriptions of individual patients revolve around theories of narcissism. Springham does present interesting group analytic perspectives, but ‘group as a whole’ perspectives are minimal. Dudley and colleagues present us with valuable expositions on working with students and art therapy trainees. They bring a wealth of experience, both as art therapy educators and as group therapists. Their first paper on learning from experience in introductory art therapy groups (Dudley, Gilroy and Skaife 1998) was later elaborated (Dudley et al. 2000). In their first work, the authors emphasize that their approach is a method of informing people about art therapy through experiential learning (in groups). They show us an interesting mix of working with the student in the as-if position of being a patient and the dilemmas this brings in both large- and small-group experiences (usually two-day events). They combine therapeutic and teaching elements within their framework to good effect: We found that we could predict the anger that often emerged during the first afternoon and that if we stayed with it the groups worked through something very important. It is our belief that these two factors together – allowing a group process to develop whilst speaking to the issues that emerge on a cognitive level – prevent participants becoming casualties of the experience. (Dudley et al. 1998, p.183)

They successfully combine the introduction of themes with group analytic perspectives, for instance looking at the individual creative expression in the

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context of the ‘group as a whole’. In their second publication, they develop their work into the analysis of research in which they build upon their experiential groups as part of a total context of their educational settings. As well as expanding the work of their first publication, they now address more succinctly the role and method of each author in conducting their respective groups. In their conclusion, they highlight the need to: giving attention to the entire matrix of the institution ‘as well as the programme as a whole;… no group happens in isolation;…art therapy education is a network of interlocking experiences’ (Dudley et al. 2000, p.197). They align their findings with the therapeutic community model of therapy education. As far as I am aware, research in art therapy in the UK is sparse. I do not know whether the work of Dudley et al. (2000) forms a sound research paper, but the findings are informative. One of the authors, Gilroy, has been instrumental in carrying the flag for research and is currently completing a new book on the subject. Another of the authors, Dudley (2001), also addressed the matter of co-therapy in art groups when she examined the collusion in accepting the heterosexual assumptions applied, e.g. husband–wife, father–mother. This, she felt, excluded other, alternative pairings. Referring to groups conducted group analytically by two therapists, Dudley asks why there was not more discussion about co-therapy in published work. She has a good point. In an admirable way, Dudley presents an open and clear account of a group analytic art therapy experience and goes on to examine co-therapists’ contributions and avoidances regarding co-therapy roles. Dudley also raises many needed questions concerning sexuality and long-held views on in-built stereotypes about therapist sexuality. The one remaining question I had was that even though she names John in her acknowledgements, she does not state that he was her co-therapist. Why was it not a joint paper, considering the title of the work? Dudley’s paper is similar to my own chapter on failure (McNeilly 2000), but in the latter my focus is not concerned primarily with co-therapy. There is one final author I would like to mention in passing. Although he is not a group therapist, as far as I am aware, Colin Teasdale has been influential in promoting art therapy within the British penal system, primarily through the use of art groups. He has been instrumental in getting art therapy recognized within the prison system on a governmental level in Britain. His approach has combined therapeutic community principles with group self-determined and group analytic art therapy modalities. For further details, see Teasdale’s article on art therapy work with offenders (Teasdale 1995).


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Conclusion This longer-than-intended review of the literature has been an attempt to focus on group art therapy development, with reference particularly to group psychotherapy and group analysis. For a more comprehensive historical account, I suggest that readers study Waller (1993), Skaife and Huet (1998) and Hogan (2001). All of these publications give detailed accounts of the British art therapy development since its inception. I hope that my own historical accounts show various points of early progression in which several authors presented their understandings and group methods from either the ‘individual in the group’ dominance or the ‘group as a whole’. What was of interest to me was how the early papers of Potts and Azima seemed more in tune than those of later authors with group analysis. What was also important was that one of the earliest art group accounts involved Foulkes being part of it, and he was clearly seeing the value of art groups at the time. With respect to the British art group writers of recent years, I was pleased to see that the group analytic model, which I initiated, has drawn its adherents. I hope that this is not only what I set in motion but also based on general theories of group analysis and its affiliations. One major disappointment is that the published material is still scarce. Hundreds of art therapists have trained since the early 1970s, many of whom will have been involved in group art therapy, if only as part of their training. As far as I know, I was the first art therapist to qualify as a group analyst, I know of at least five who qualified after me. Further to this, a number went on to other group psychotherapy training and I’m sure others whom I do not know personally are following this line of training. However, one of the areas that was not developed in the group analytic/psychotherapy publications was the use of the ‘group as a whole’, either in its fuller theoretical perspective or in its applied usage in various writers’ methodologies. I think that British authors openly question their techniques in the use of art within psychotherapy groups while showing a growing sophistication in respect of the multiple elements encountered in group art therapy.

Chapter 8

That which binds together can also pull apart: new theory and technique

By the early 1990s I was finalizing my ideas for a national conference on art therapy theory. Although my clinical work as an art therapist was taking a back seat, I was contemplating a withdrawal from further academic exploration in art therapy. I was then approached by Portuguese colleagues to consider working with them in developing their society of art therapy in Lisbon, Portugal. There followed a healthy working alliance that gave impetus for the development of the new theory that forms the major part of this section of the book. I was fortunate to be asked to present lectures internationally, and I began to think about art therapy and group analysis within more extended and philosophical perspectives. Four papers emerged, which I feel set the scene for my later work, all within the study of group analysis and group analytic art therapy. These were written for international conferences and were unpublished. What each of these papers had in common was a development of thought upon pivotal points that hold things together or drive them apart. What held such words and ideas together, pushed them apart or created a sense of balance? I also questioned assumptions where particular emotional states were seen as opposite, for instance love and hate. A patient asked me: ‘How can I hate someone I loved?’ I responded: ‘Love is not necessarily the opposite of hate; it is a different emotional state. You can hate how someone has damaged your love.’ I would suggest that in the majority of therapy/psychotherapy transactions, there is a constant flow of elements continually moving together and apart. Thus, encounter can be experienced as a development from alienation, or it can lead to alienation, such as flight from therapy. The dynamic struggles of conscious and unconscious oppositional forces are played out

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THAT WHICH BINDS TOGETHER CAN ALSO PULL APART

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continuously, which can lead to greater harmony and balance or, on the other hand, to greater splitting, fragmentation or even disintegration. The exploration of this whole array of thoughts and feelings rests upon finding pivotal points. Within the group, these are discovered in the working nature of the group, which is composed of various interactions, along with the group analyst’s (and others’) interpretations. Within the group analytic art therapy group, there is also the extra dimension of imagery, and of course, a picture is worth a thousand words. For example, a universal picture of love is a heart with an arrow through it. In art therapy, many people have produced this image placed beside a heart with a jagged line through it. This speaks for itself. From here, I would like to present a condensed account of these four papers.

‘The Deep End of Group Analytic Art Therapy: A Swan Song’ This was the original conference paper that I presented as a keynote address in Birmingham in 1998. Its aims were two-fold: to present the depth aspects of group analytic art therapy and to place them centre stage in the British art therapy literature. Contrary to this, the paper acted more as phoenix rising, as many new ideas emerged from the ashes of that original intention. You might now see some meaning in the cover painting of this book if you have not done so already. The ‘deep end’ in the title brings to mind an image of a swimming pool as well as being a phrase used to emphasize how one can be in a particular situation that feels intense, possibly dangerous, where one has to work hard to stay afloat. The ‘swan song’ denotes the song that a dying swan is said to sing, a last professional act, a dramatic, flamboyant parting gesture. The swan metaphor is descriptive of what occurs in all insight-oriented therapies: there appears to be a passive surface manifestation while the therapist paddles like crazy underneath. As stated in Chapter 1, when I first began to develop my ideas and methods in the late 1970s, I often felt that I was floundering at the deep end and feared drowning. In many ways, this highlighted for me that in those early years I felt like a lone voice, a maverick for group analytic art therapy. To come of age, group analytic art therapy had to survive being within the deep end of the art-therapy fraternity while individual art therapy played in the shallow end. I do not imply that individual art therapy does not have its own deep-end scenarios, but most art therapy theory and practice had been formulated on an individual basis and so had

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firmer foundations. Some time before the conference, a colleague asked me to present a lecture within two days and asked for a title. Spontaneously, I responded ‘being thrown in at the deep end’. This brought fear but it also opened up a creative flow. In writing the paper, I recounted how my father had thrown me into a river when I was a young boy. I remembered the fear and shock that I incurred but then I recalled the sensations of learning to swim, the excitement of being immersed and my growing power in moving through the water. The sun glistened and bounced off the water, and the ripples looked like moving silk. There was the smell of the river and the surrounding countryside, and there was laughter after the tears. Much was gained from being thrown into the deep end, and my father was at hand and in my peripheral vision during this whole experience. In art therapy there is a parallel, with the patient going beyond verbal language into an evocation of the other senses, of concretizing visual imagery, of conjoining smell and tactility. We throw our patients into the experience or help them into the shallow end. The dynamic field that is evoked shifts between a two-dimensional and a three-dimensional framework. When language is the main, or only, currency used in psychotherapy, the present and past are negotiated in a linear way via thought and memory. As such, this is a two-dimensional, horizontal process. Although the same elements are present in art therapy, the introduction of art materials and the tactile and olfactory elements combine to produce a different dynamic experience. Art therapy can create a more pictorial bridge between the past and the present. Therefore, one can begin to grasp that the depth or deep end of psychotherapeutic art therapy is built upon sensory evocation in a different way, although not exclusively so, from primarily verbal psychotherapy. As in my river analogy, one has to be immersed constantly in the whole sensory experience (primitive, unconscious) while keeping one’s head above the water. Here, one sees a continuous interplay of pulling (evoking) and binding (immersing). The word ‘evoke’ is defined as summoning, calling up, conjuring, provoking. ‘Immersion’ is described as being plunged into liquid; to be deeply engrossed. Hence, this combination of evoking and immersion is appropriate. I was somewhat surprised when I could not find any published material on these words within the psychotherapeutic literature that I explored.


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Two-dimensional to three-dimensional triangles The place of the triangle within art therapy has been well documented in British literature. I alluded to triangular frameworks in one paper (McNeilly 1983) and included diagrams of triangular involvements within art therapy. Whoever initiated the triangle concept is owed a great debt of thanks. However, it is not my intention to start an historical investigation. The triangle is a cornerstone in our art therapy infrastructure, but it is time to move on with further modifications. Later in this chapter, I will present new developments of the triangular theories that were elaborations of the therapist, patient, image or transference, counter-transference and image. Although many of the papers on this subject were illuminating, the triangular descriptions were described horizontally (flatly) in the three-way processes/interactions, and triangular conformations did not permit consideration of such areas as: ·

the centre of the triangle

·

hierarchical positions in the triangles

·

dominance and submission of the triangle points

·

the concept of the triangle as a pyramidal structure or a four-sided set of triangles

·

the multiple triangular configurations occurring in art groups.

As a result of the study of these omissions, I created a number of concrete models (Figures 8.1–8.11), which I hope will illustrate further developments. It is my intention that some of these new triangular descriptions may influence art therapists working individually. In art therapy literature, Figure 8.1 is a classic pictorial formulation, as described in most cases of individual art therapy. The three words in the figure can be replaced by other words, such as transference, counter-transference and image. Triangular/tripartite descriptions are not exclusive to art therapy, cf. Freud’s id, ego and superego and Malan’s triangle of conflict: hidden feelings, anxiety and defence. However, as far as I am aware, Freud’s model is not conceptualized as a triangular configuration but is seen vertically, whereas Malan (1979) speaks of ‘triangles of conflict’. In individual art therapy, a singular triangle would be explored, i.e. the creation of the image by the patient and how that related to the therapist. Another version might be the patient’s creation of an image and the

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Image

Patient

Therapist

Figure 8.1 General diagram of individual art therapy.

conscious/unconscious (cognitive/primitive) triangle is evoked. At this time, this triangle takes precedence, with the therapist being on the sidelines. Depending on the situation, intra- and interpersonal dynamics will give particular form to the triangle conception. Accordingly, the art therapist will determine how he approaches the triangle according to his own theoretical and practical beliefs. Some therapists make decisions on whether they place the image or the patient at the apex. The therapist may be placed at the apex at times of intense transference conflict; when spontaneous or unconscious elements arise, in either the creation of the concrete image or the conceptualization of the process, the pinnacle will change dynamically. A pinnacle does not exist without a single, double or multiple base. Therefore, whatever is driving and giving form to the final triangle’s conceptualization needs to be understood beyond a horizontal plane. Its life is three-dimensional. For example, if a patient produces an image, it may be influenced hierarchically (vertically): the image is bound primitively to childhood and has to be transposed through the patient’s adult self and given to the therapist, who may be seen as a parent or teacher. Another variation may be that particular periods of therapy are maintained through establishing a dominance of one point of the triangle with the submission of the others, e.g. maintenance of the therapist in a dependent position, with images produced in order to maintain it. The interplay in Figure 8.2 is between patient and therapist. The main interaction is horizontally biased but dips downwards. This could also be


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described as a dual position. The creation of the image, the going beneath and beyond the image in verbal exploration and the significance of the therapist/patient relationship will dynamically alter the dual into triangular configurations. See also Schaverien (2000, p.71) for a similar presentation. Patient

Therapist

Image

Figure 8.2 Patient–therapist dominance.

The triangle in Figure 8.3 draws our attention downwards. If, for example, one places primitive processes at the base point, then one can begin to formulate the power as driving upwards towards the other two points.

Patient

Therapist

Point of dominance

Figure 8.3 Dominance of image dynamics.

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Figure 8.4 shows a more complex sequence, from the patient working on an internal triangle configuration, and how this process moves towards a second triangle, which is then bound externally. In many ways, these triangular systems may also be seen as circular mechanisms or dual feedback loops. One can also develop deeper or more comprehensive levels of understanding if one replaces other words at the three points, e.g. symbols, words and blank page.

Concrete imagemaking

Image

Therapist

Patient

Primative processes

Patient

Figure 8.4 Loops of interaction.

We can develop a greater dynamic understanding of the art therapy procedure if we formulate our ideas by looking at the triangle as a living force, i.e. the energy goes upwards towards a pivotal peak, downwards in the search for unconscious or repressed material, sideways as the therapist takes side stage from the patient and their image, or in a circular dynamic flow. Variations on this can be seen when we look at two sets of triangles pushing against each other or moving in many directions, as in Figure 8.5. Figure 8.5 shows a more complex set of ingredients. In practice the art therapist may view the situation horizontally, i.e. both patient and therapist sit at a table while the image is made. Therefore, if one applies thinking along with developing practice to Figure 8.5, this allows the therapist to grasp the various fields of attention, which can be elaborated infinitely. Figure 8.6 is intended to show that within individual art therapy there are multiple triangular configurations at play, both overtly and covertly, and they are in a state of constant flux. This is expanded even further in group analytic art therapy. The various triangles either stand out separately or are expressed and exist in conjunction with one another. For example, the three


Patient

Therapist Countertransference Transference

Conscious

Patient

nconscious

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nconscious

Concrete image

Concrete image

Countertransference

Conscious Therapist

Figure 8.5 Therapist/patient field of interaction.

Figure 8.6 Multiple triangles in individual/group art therapy.

dark triangles might be therapist, patient, image or transference, countertransference and image. One of the clear triangles may be external passive self; internally raging self; and lack of external concrete image. Figure 8.7 is intended to show a generic picture that incorporates all of the triangles previously described. Here, we focus our attention not only on the central core but also on the points of the triangle and the empty part

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between the circle and the triangle walls. As with gestalt and group analytic work, the figure/ground movement is changing continuously. Our peripheral vision and focus have to be fluent in order to see how the triangle and circular motifs interact. Like the ‘individual in the group’ and the ‘group as a whole’, a new variant is the triangle in the circle as a whole.

Figure 8.7 Dynamic triangle/circle conjoint.

Figure 8.8 brings the two-dimensional triangle into a three-dimensional view. We now begin to give body to our therapeutic perceptions, which may have been bound in a linear way when going from one two-dimensional perspective to another. We now move from the base to the apex, one side to another, to the power within (dark circle in middle) from the apex to the four corners. This is now more exciting. I made a passing reference to this area in McNeilly (2000), and I am now developing these ideas in more detail. Parallelling Freud’s views on the unconscious, one can conceptualize the power within the triangle coming from underneath and forming the point of the triangles/pyramid in a release of instinctual tension. If viewed downwards, there may be a dynamic flow from superego through ego to id through centripetal force. The triangle has now become multifaceted, with a richer field of vision within both individual and group art therapy, even for those using structural techniques such as the production of themes. As far as I am aware, to date the literature has not considered such perspectives. Our imaginations have had to evoke three-dimensional images from previous


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Figure 8.8 Three dimensions (triangle/circle conjoint).

literature, which then become full of body (Schaverien 1999, pp.79–102). This raises many new questions, such as what are the differences between the triangular equations and pyramids and how is this clinically evidenced? What occurs at the sides of the pyramid? Are the four points of the pyramid different positions: patient, therapist, image, language? If so, is the pinnacle a desired point of change? What is in the centre of the pyramid – trauma and happiness? In the process of resolution, the climbing of the pyramid may not be successful unless the centre of the pyramid is excavated and transcended. In the conventional pyramid, there is a reliance on four cornerstones, and it is possible that our historical triangular roots may have done British art therapy a disservice, i.e. those art therapists who set the image foremost may have undermined the foundations of language while those leaning towards verbal psychotherapy (myself included) may have weakened the cornerstone of the image/aesthetics. Taking the pyramid image further, I want to consider four sets of triangles laid upon each other. As the sun moves over the pyramid, one side becomes brighter than the others. Likewise, this occurs in therapy in the shifting of dynamic rays, and the building of the therapeutic pyramid comes from bottom up. This is similar to life experiences in that we are born, grow and die. Unlike the pyramid, we build or grow in many ways; we progress and regress. There is a need to establish and find the four cornerstones and

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their relationships with the triangular configurations, with the potential for seeing such therapeutic frames dynamically. Such cornerstones may be id, ego, super-ego, or others, as just one example. Set upon these corners, the art therapy triangles are erected, which become more apparent as the therapeutic rays (of the sun) move from one dimension (side) to the next over periods of time and space. The four triangles should be placed on the edges of the pyramid base and folded upwards (Figure 8.9). One can then envisage the finished construction as a pyramid. Further, if one applies Foulkes’ views on the foundation matrix (Foulkes 1986, pp.130–32) with Jung’s collective unconscious (Jung 1960, p.152), one examines what is beneath the base of the pyramid. Image

Image

Therapist

Patient

Transference

Countertransference

Superego

Pyramid base

Ego

Mother

Patient

Others

Parents

ID

Father

Figure 8.9 ‘Do it yourself ’.

Grandparents

New family


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Sidestepping a little, what is the significance of a square of paper or canvas being used predominantly in art therapy, rather than a circle, triangle, or other shape? Can this be ascribed to the archetypal influence of the pyramid? Many houses are four-sided with a pointed roof. Therefore, the square/rectangular piece of paper establishes a base for three-dimensional creations, either materially or imaginatively, to be produced akin to pyramids and houses. Another interesting point may be that the four corners of the paper represent invisible cornerstones within the art therapy framework waiting to be built upon. Other questions specific to art therapy may be: Is the completed concrete image the pinnacle or the base of the pyramid? Is the dynamic force centrifugal or centripetal? Perhaps the therapist is in the middle of the pyramid, with the patient building his life around the therapist. Alternatively, the patient may be inside, in the form of fear, regression or depression. In ancient Egypt, the Pharaohs were buried inside the pyramids with their treasure. So what awaits us if we excavate the centre of such therapeutic pyramids? Figure 8.10 is the logo of the Institute of Group Analysis (Foulkes 1986, p.81). I do not believe that the image does justice to such a rich theoretical and practical psychotherapy. This logo gives an impression of looking down on to the horizontal circle of the group. People appear as squares, with the connections between them displayed as broken lines, and there is no crossing over the circle. The central circle is open to interpretation, as, for example, a central set of ideals and beliefs, the ‘group as a whole’ as a focus, or simply the central table holding the box of tissues. However, if this latter point were the case, where is the box of tissues?

Figure 8.10 ‘The setting in a circle’ (Foulkes 1986, p.81).

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Figure 8.11 is a pictorial presentation of verbal group analysis on the left and group analytic art therapy on the right. The small squares at the top of the art group illustration depict the images. One can imagine a drum in which there are two concentric circles held together by a number of forces, e.g. tension of the two skins, a vertical frame or wall, the sound or pitch (group analytic association and resonance). The top circle is equated with Foulkes’ dynamic and the bottom circle with the foundation matrix. As can be seen, there are many interweaving lines within the overall image. The spaces between can represent silences, absences, concrete images not created in the art group, isolation, fear, unconscious roots of resonance that push things together or pull them apart.

Verbal group

Art group

Figure 8.11 Dynamic and foundation matrix.

Generally speaking, the group analytic art therapist must be aware of all parts of these networks. He must be able to encourage the expression of concrete imagery and understand its individual creation. He must be able to immerse himself in the process in which the different people (nodal points) are placed and connect. The individual’s past and present is taken into account, along with the whole group’s past and present events. One must dive deeply at times in order to find individual and group contextual issues relating to such complex processes. The therapist should know when to let the group find its own way of swimming and when to come to the group’s aid with interpretations or clarifications. This will either take the group to


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the shallow end or support and encourage the group to go into deeper water, dive and take risks. Liberation is clear to see when insight is acquired and resolution occurs, which in turn encourages greater risk-taking. One must be prepared to paddle in the silences; to accept and understand the resistances in creating imagery along with verbal resistance; the unexpressed angers; the testing of the therapist. In addition the formlessness lingers in the spaces when words and concrete imagery are not enough at particular times. Silence may be one expression of formlessness but may also be forms being withheld. In these formless spaces, there may also be unexpressed feelings of envy, jealousy or negative competition. I shall now move away from the structural and diagrammatic presentations into a theoretical presentation of dualities. This, I trust, will build on the triangular configurations already stated.

Opposing forces and the attraction of opposites Within groups, there are: ·

opposing forces existing in many forms

·

opposites expressed and evidenced as either separate formations and symbols such as states of separation or points of unity

·

a bridging process for the attraction or repulsion of opposites.

In trying to understand and work with groups, these three elements should be accommodated and used accordingly. If the inherent dynamics and surrounding opposites are not fully understood and utilized, this may lead to defensive positions, with prospects of chronicity or disintegration. The assumed opposites of good/bad, projection/introjection and manic/depressed are points in case. Focusing on the opposing forces briefly, these may at first appear to be polarized, contradictory, or potentially destructive. Then, if the deeper meanings within opposites are recognized and harnessed with therapeutic interventions, resolution should occur, not only for the opposing forces (often presented by two individuals with extremely different views and ideals) but also for the ‘group as a whole’. This can, therefore, enhance the group, rather than reduce the conflict to one side of the argument. Returning to Bion’s basic assumptions, one can see the dualities within the basic assumption of pairing: dependency in opposition to independence, fight/ flight as a variant of opposition and attraction. Earl Hopper has brought to our attention the idea of a fourth basic assumption. He writes:

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Groups and group-like social systems are likely to evince basic assumption processes, not only those adumbrated by Bion, but also those of a fourth basic assumption as outlined in a preliminary and partial way by Turquet, Kernberg, Lawrence, Bain and Gould. This fourth basic assumption is a manifestation of the fear of annihilation and its vicissitudes, which are universal and ubiquitous, but especially intense and pronounced among those people who have been traumatized. Thus… this fourth basic assumption is also universal and ubiquitous in groups and group-like social systems who have been traumatized or whose members (or at least a large number of them) have been traumatized. (Hopper 2003, p.66)

Hopper offers a new and interesting dimension that helps us to understand and contain the deeper destructive aspects of the group. The dualities of fusion and annihilation are elaborated. In line with my own study, one can include oppositional forces within Hopper’s schema. Within my overall hypothesis, there is one primary factor that drives and binds it. Within each opposing force, there are already latent elements of that which is fought against in the opposite force. Inadvertently, each opposing force centres upon searching for the other’s opposing ingredients, which at first are consciously denied. Unconsciously, this process is linked to deeper-seated denial and expressed through projection. A fight ensues between what is perceived to be different externally and that which is within oneself, and is found to be a mirror image of one with the other. Such processes move through various stages of rejection and conflictions to insight, equilibrium and harmony. What was it that led me to such theoretical formulations? Several years ago I was asked to help a team deal with their difficulties. The opposing forces within this group were formed strongly at different levels and had reached an almost fused state. It was as if an impasse had been created. Central to this was that only one original staff member had remained; the rest, the majority of whom were women, had left their employment. The new team was primarily male. The old team was equated with feminine caring and the new team with masculine authoritarianism. The new team raised oppositional conflict, while the old harmony had died. Unresolved anger, rage, hate and aggression formed the new dynamic field, which had now become an impasse. Democracy had been replaced with autocracy. There were many interesting features. However, there was one small interchange within the course of this training event that crystallized the thesis I


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am presenting. Throughout, a man and a woman took up polar positions: the old/new, calm/passive, extroverted/introverted and timid/fiery and explosive. As the day progressed, it became harder for the group to keep to task, as in Bion’s work group (1961, pp.143–6), with these two individuals continually taking centre-stage, as in Bion’s basic assumption pairing (1961, pp.63–4). Things reached a crescendo when these individuals actively and passively brought to life the many polarized, oppositional dynamics of the whole team. At the peak of their distress these individuals were inches apart physically before they were separated. The team members adhered to each individual accordingly. There was a great fear of violence and annihilation (Hopper 2003, p.59). However, what was not seen was the strong link or bond between them. One could no doubt see the destructiveness present, but I believe there was an unspoken wish for unification and merging. On the one hand, there was the wish to jump inside the other destructively; on the other hand, there was a passive response that appeared inviting or seductive. Both parties (and the ‘group as a whole’) seemed to be wanting to project unwanted parts while trying to find parts in the other that they did not possess in the same way. Here, the attraction/repulsion of (apparent) opposites was an elaborate and intricate dynamic search for all involved. Hence, opposing forces, oppositional symbols and forms of attraction/ repulsion of opposites materialized. Turning to the ‘group as a whole’, what does this tell us? So far, I have highlighted the (oppositional) forces described in Bion’s and Hopper’s theories to explain the overall group mentality. Within my group analytic practice, on the day of the event I went on to interpret how both of these individuals were expressing and speaking for the group when the various dynamics were elaborated upon, i.e. old/new, male/female, democracy/ autocracy, maternal/paternal, envy/gratitude, etc. Further to this, I looked with them at how an apparently oppositional pair was in the foreground with a helpless group in the background, at the attraction and how each individual was resonating to each part of the matrix, i.e. the old was the foundation matrix while the new was the dynamic matrix. The network of communication had, thus, reached its impasse. The dynamics I have described within this team, and the method of understanding and technique I have experienced in other settings, are almost mirror images and may even turn out to be universal. Another element that can come into play is this: when such processes are worked with and analysed, a new sense of union and connectedness can be

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enabled. It is not uncommon for enemies who fight one another to go on to become allies and friends. Some patients have told me they were bullied as children but once they stood up to the bullies they became lifelong friends. Therefore, is bullying a state of total opposition, or is there something of purpose in the union of the bully and the victim?

The space at the interface Let me speak a little about the space between oppositional forces. At the peak of the struggles described earlier, there is an almost electrifying build-up of tension (Ezriel 1950). When conflicts and fights reach such a stage, they take various forms, for instance, finger-waving, threatened blows or backing off, a rise in adrenalin. One could also see such suspended states as a form of hypnotism. Could one equate the finger-waving with Foulkes’ views of the baton of the group conductor? There are also verbal concepts that come to our aid in such oppositional struggles, e.g. ‘His bark’s worse than his bite!’ Irvin Yalom writes of the struggles of the dyad within the group: A dyadic relationship, too, which has weathered much stress is apt to be an especially rewarding one. An experience in which two individuals in group therapy experience an intense mutual hatred and then…resolve the hatred and arrive at some mutual understanding and respect, is always of great import. (Yalom 1970, pp.269–70)

A significant factor within our exploration is the space at the interface of opposition. The paradox here is that in reality, nothing of substance is there apart from air and body heat. However, it is extremely full of emotion and conflict. All methods of psychotherapy contain such paradoxes, just as the dark is felt as a presence rather than as the absence of light. In speaking of opposites, we tend to put one or two factors in opposition. We use the word ‘or’ to keep them separate, which leads us to a view that they are extremely different, e.g. good or bad, happy or sad. Often, we put the positive before the negative in emotional descriptions. When connecting such terms, we tend to use the word ‘and’. This may be seen as a bridge, a way of forming links, permitting the attraction of opposites across the interface. People claim that ‘opposites attract’ when they fall in love. The expression ‘There’s a fine line between madness and genius’ combines two apparently opposing forces. However, these may be rather naive descriptive marriages. The ‘fine


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line’ concept brings to the fore a very powerful image of fineness that holds and separates: Eros and Thanatos. A year before I wrote my paper on Opposites, I wrote a paper entitled ‘Encounter or Alienation’. I began a more detailed study of the word ‘or’. I questioned the two words either side of ‘or’ on which that paper was written. Such themes draw our attention to either side, giving less attention to the middle. To achieve this, I began to develop how alienation is within encounter, and vice versa. ‘Or’ was now a pivotal word within such a study. Therefore, it united the whole title into a system of attraction from one force to the other. ‘Or’ was at the space at the interface. There has been a long debate or split between the ‘art’ and ‘therapy’ in art therapy. Adherents to either side, I believe, add further to oppositional splits, as compared with taking the whole title ‘art therapy’ and applying or expanding it accordingly as a united whole. A type of preciousness has evolved through these struggles, with one side emphasizing ‘Art therapy’ and the other ‘art Therapy’. When Foulkes speaks of opposites and opposition, under the aegis of conflict, contradiction and separation, he says: ‘There can be no question of group versus individual, or individual versus group. These are two aspects, two sides of the same coin (Foulkes and Anthony 1984, p.26). Furthermore: Group-analytic method and theory do away with pseudo-problems such as biological versus culture, somatogenic versus psychogenic, individual versus group, reality versus phantasy. Instead we endeavour to use concepts which from the beginning do justice to an integrated view. (Foulkes and Anthony 1984, p.27)

These comments by Foulkes and Anthony are in keeping with my own thesis on the integration of opposites. However, their views are framed within the area of conflict as compared with my view on the attraction of opposites. When I wrote the opposites paper, I could find little beyond the views of Jung and his followers on opposites, about which they have contributed considerably. Jung speaks of the archetype being symbolized through opposites. When a group is formed, for whatever reason, archetypal symbolism emerges. As these are seen initially as polarized extremes, they are often set against or in opposition to one another, e.g. sick/healthy. An accepted group analytic given in the heterogeneous group is that differences must exist within the group; Foulkes saw the merits in this. There have been many times

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in my groups when the group would go to great lengths to expel conflict rather than seeing it as a necessary ingredient with oppositional forces to be embraced. There are particular forms of opposition in the group: parent/child, therapist/patient, group monopolizer/silent member, joker/pathetic member. Less obvious forms exist in the individual’s motivation being opposed by a resilient resistance in others against change. Another can be seen in envy opposing the projected fear of being envied.

Art group vignette In an art group session, the opposing forces rested on not living up to expectations and in putting up a front. Images of jokers (clowns), family scenes about being chastised, a child being made to stand in the schoolroom corner, as used to occur in Britain as a form of punishment, and black walls of depression were created. When the group began speaking together in the verbal section, there was an initial view that such forces were contradictory and opposite, that is, putting up a front, guarding against feeling vulnerable and pulling away. The joker carried similar messages; the family and school scenes gave the impression of uniting for either love or learning, and punishment when unsuccessful; in the black walls of depression was enacted a sequence of repelling those who got near while the depressed person retreated, i.e. push–pull. My later interpretation focused on their mutuality: in order to deal with not living up to expectations (being loved, not good enough, depressed) they kept acting in ways which maintained fronts, not only as defences but unconscious attempts to locate internal integration (peace). If such processes were kept as acting (linked to the joker archetype) this maintains the split. If seen as expressions of different parts of themselves this has more chance of leading to unification and acquisition of acceptance. Still with this theme in mind, a man in one of my groups spoke of continually being in the shadows of his sisters. Likewise, a woman maintained a stuck-in-the-shadow-of-others position in the group, both as a gesture of resistance and as an attack on me. I was representative of all that was evil in men. Here, the oppositional forms were shaped as the man attempted to come out of the shadows of others while the woman perpetuated the idea of destructive forces in the shadows. This was originally thrown on to her by her earlier abusers in childhood. The former is a search for the denied shadow self and, thus, integration (finding solidity will bring its own shadow). The latter is a holding of the others’ destructive shadow, with the


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path leading to atrophy of the self. The ‘group as a whole’ expressed forms of opposition, which were evidenced as struggles between the group ideal of cure, as compared to here and now struggles which would lead towards personal integration, as one illustration. Further development of this would be tangential at this point. The I Ching (or Book of Changes) says: In general, opposition appears as an obstruction, but when it represents polarity within a comprehensive whole it has also its useful and important functions. The oppositions of heaven and earth, spirit and nature, man and woman, when reconciled, bring about the creation and reproduction of life. In the world of visible things, the principle of opposites make possible the differentiation by categories through which order is brought into the world. (Wilhelm 1968, p.148)

I hope that this quote illustrates my earlier points. In the group where conflict dominates, there are parallels with a galloping horse in not forcing resolution; like the horse, it will run from us. If the conflict is permitted freedom between the poles, then there is a chance of greater integration and order in the world of the group. The space at the interface becomes stronger. Jung refers to the psyche as a dynamic system in constant movement and that is self-regulating. He saw the libido as the general psychic energy but not necessarily as a constituting force, and he saw it more in descriptive terms. In her introductory book on Jung, Frieda Fordham presents an account of Jung’s perspectives on opposites: The libido flows between two opposing poles – an analogy might be drawn here with the diastole and systole of the heart, or a comparison made between the positive and negative poles of an electric circuit. Jung usually refers to the opposing poles as ‘the opposites’. The greater the tension between the pairs of opposites the greater the energy; without opposition there is no manifest energy. The opposites have a regulating function (as Heraclitus discovered many hundred years ago), and when one extreme is reached libido passes over into its opposite. (Fordham 1953, pp.17–18)

My ideas on opposing forces are in keeping with Jung’s views. Within the group, such forces come into play through the internal workings of each individual and how these are communicated and processed. In turn, the power of the ‘group as a whole’ influences each individual further. I agree with Jung that the flow of energy is that of the libido. However, I believe it to

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be more than intrapsychic, as the flow of energy moves from the inner polarities to the outer world and vice versa. The intrapsychic and outer world encompass the space at the interface and the outerface. Finally, one more point about the existence of opposing forces, the forms created and the attraction in the group. The individual is in a continual state of flux or, as Heraclitus described it, a ‘universal flux’ (Khan 1979). Dynamics are fluctuating, driven from oppositional pole to pole. If his opposites are in a state of high conflict or disturbance, then the individual will seriously question his power for relatedness and will suffer in splendid isolation. He will struggle with his own autistic position (Foulkes and Anthony 1984, pp.259–60) in the form of his symptom formation against the group (society), and his oppositional form of isolation will hinder others’ attempts to include him in the group. This group dynamic could also be ascribed to an attraction of opposites. Equally, the resistant individual may choose to repel the attractive forces with his narcissistic defences intact. On the other hand, one or more individuals may break through this, as they have something within their own character that is attractive to the isolated individual; this process has a counter-balancing effect that becomes harmonizing. This, therefore, occupies the space at the interface, and polar balances are achieved. Each person in turn searches for internal integration through others and the self. The tripartite framework of oppositional forces, forms and symbols and attractions can be used to understand and to describe many other aspects of the group beyond this short vignette.

Polar balances The idea of polar balances is a development from the ideas I postulated about opposites. Earlier, I spoke about the pivotal points and the use of language with words such as ‘or’ and ‘and’ to address these issues. The idea of a polar balance is not dissimilar to that of a pivotal point or a centre of balance, but there are differences. Within group analytic terminology, there has to be a polar balance between the individual and the ‘group as a whole’. A central tenet of developing polar balances in the group rests upon seeing the group as a system in dynamic flux and equilibrium. A similar perspective is evident in the paradoxes portrayed in golfing language, e.g. ‘Don’t hit the ball’ (the ball is in the path of the golf swing), ‘Stand still’ (the swing moves upon a still body axis). Opposites are contained in the circle of the swing. After getting a hole in one, the golfer has to buy everyone in the club house a drink, when surely it should be the other


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way round. Could this be a way of alleviating envy? In group analysis, people sit in a fixed circle of chairs while dealing with the movement of their lives. Another polar balance is achieved in group silences, with much internal activity taking place in each person in the silent nothing-is-happening form of the group. This is also evident in most art therapy settings, where during the active process of creating a concrete image in order to develop a polar balance there is a process of stillness before the first mark, creating the image, completion. This process contains many opposites in which the image-making is active and the creator, generally, silent. When complete, although the finished picture is still material, the cognitive therapeutic work comes into play. If one compares silence with the blank page (McNeilly 1989, pp.157–8) in art therapy one can see parallels in the complexity demanded in going through the silence to making the first marks on the page in order to reach a polar balance. Language in general has its cultural accents and has ways of framing polar balances between opposites. For example, in my home town in Ireland, when shopping one might say: ‘You haven’t got a pound of sugar, have you?’ This is a statement and question combined, stating the worst in the first instance, with the potential disappointment of having no sugar being avoided. Such a sentence could be seen as defusing the situation, maintaining a polar balance between expectation and disappointment. In a recent group session, I suggested that the struggle to achieve perfection was a maintenance of disappointment. In psychotherapy generally, one can see similar balancing acts used to deal with polar positions. Sarcasm is one tool that comes to people’s aid here, for example, a patient may say or paint something they feel is very important to them, but they may get little response and feel ignored: ‘So, what I’m saying [or have painted] is really fascinating!’ Or the therapist yawns: ‘I must be your most interesting patient!’ Both illustrations are an ironic way of stating the opposite of what is felt. As such, they are indirect external attacks while maintaining an internal polar balance between the opposites. In all groups, powerful forces are at play, which determine its life. Polarities and polarizations are points at either end of various spectrums. Sometimes we feel we can see and name these when we locate either end of the spectrum. At times it is more difficult to see and name the (invisible) lines between them. For example, radical ideas may engender conflict in the group and are perceived as divergent points that appear irreconcilable. However, the power of the differences binds the poles together. This can be

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seen, for example, in sado-masochistic relationships. This term seems to imply a type of symbiotic relationship. To understand sado-masochism differently, we need to move away from the idea that people take up a different identity (pole) and are one or the other. Although I have not explored the literature in detail, I believe that few writers would see people being only one or the other. In the context of my current theory, I would suggest that the polar balances are maintained on the surface by one party taking up one pole, and vice versa. However, if one focuses on the connecting line, we ask ourselves: is the apparent sadist projecting his own internalized masochisms in the form of sadistic acts, seeking revenge on earlier abusers? In turn, is the apparent masochistic person willing to accept the other’s sadistic acts as a way of allowing another to punish, short-circuiting self-punishment and reaching levels of atonement of previous sadistic thoughts, revenge and attacks on others? It may also be a form of allowing another to obstruct such powerful internal processes from being externalized. Here, another acts as an agent of repression. In this type of scenario, although there are powerful opposites and opposing forces, the polar balance seems to be a much deeper component, as many of these elements are expressed and conceptualized sexually and analysed within the area of instincts and impulse cathexis. To keep one’s eye on the line (level) or balance, we keep in mind the interrelatedness of both poles. Art therapists will be familiar with a whole array of created imagery that expresses sado-masochism. Such imagery can act both as a powerful channel of expression and as as a container for it.

Polar positions With group analysis and individual psychotherapy, there are numerous illustrations: ·

the individual described as a nodal point : the group matrix

·

symptom formations : healthy parts

·

defences and resistances : motivation and change

·

verbosity : silence

·

selfishness/self-centredness : altruism

THAT WHICH BINDS TOGETHER CAN ALSO PULL APART ·

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optimism : pessimism (the ‘and but’ syndrome, i.e. every positive hopeful comment offered by others is blocked, with ‘and but’ – always having the last word)

As I stated earlier, although I place these terms next to one another, this does not mean that they are necessarily opposite. A heterogeneous group may have the intent of minimizing polarization through accepting differences. Each individual can and will take up polar positions at different times, e.g., the persistent latecomer. In comparison, homogeneous groups may intend to lessen polarization through a type of everyone-in-the-same-boat experience, e.g. Alcoholics Anonymous. A mentality can evolve in the enemy without, thus fostering isolation or polarization from other parts of society. However, groups such as Alcoholics Anonymous have enormous benefits in that they create a sense of new belief and belonging. As part of the process of polarization and finding balance, there is a need to separate, differentiate and unite. With more extreme positions or complexes, it may be difficult to find a balanced view of a location of goodness in destructive acts, for instance euthanasia, or destructive ingredients in good intentions, e.g. the line between mothering and smothering. Once again, art therapists will have experienced many images being placed in such positions, e.g. male/female, murderer/victim.

Polar balances and imbalances One can explore polar balances with the analogy of a seesaw. If the seesaw is not in use, it may be balanced or not according to various elements and still has the potential of movement. When two children climb on, one each end, the seesaw moves into imbalanced/balanced action as the game gets under way. If the children are of similar weight and the aim is mutual enjoyment and collaboration, the polar balances will feel harmonic. On the other hand, if there is a difference in weight or there is competitive/destructive intent, the experience will feel conflicting and disharmonious. In both scenarios, the central base or pivot has to be still and secure. (This principle is equally applicable to most psychotherapies.) In the seesaw game, some children may use their weight to gain advantage, while lighter children may turn to guile and skill. When we explore the combinations of polar positions, balance and imbalance, we should try to conceptualize them as a whole, as in group analysis. One sees many images produced in art therapy with this in mind, e.g. the scales of justice. One way to do this is to think about the following:

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Centre of balance Finding oneself has become a cliché and implies something complete or substantial and fulfilling. This is in contrast to possibly finding many selves or centres. For a person with anorexia or bulimia, this may be inconceivable, as one of the symptoms is a sense of emptiness. However, deeper therapeutic work can often lead the person through their anorexic emptiness to a deeper centre of hate, rage and despair, where there are fuller feelings (see Chapter 11). Returning to the seesaw, the centre of balance in concrete terms is formed by the material components used in making the seesaw: the weight of the wood or plastic, the central pivot, the power of gravity. When the seesaw is moving up and down harmoniously, the centre is still and, possibly, blissful. The movement becomes one unified feeling. As the game develops, there needs to be an agreement reached by the two children. All is well if both agree harmoniously; however, one child may want to continue and the other may not. It is often stated that children get bored easily, but is this true? Can the child tolerate bliss and harmony for only so long before the need for conflict and disharmony comes into play? Just like the seesaw, the psychotherapy group needs to maintain its stillness/stability in order to be used time and again to come back to play, and it becomes a centre of balance/imbalance. Over time, it becomes internalized for the individual to play out their external life situations. It also contributes towards the continual working through of polarized positions that also forms part of the centre of balance. This is evidenced in such things as moving from disagreement to agreement, finding common ground while accommodating differences, and moving from resistance to compliance. Regarding art therapy symbolism once again, this is vast and immediately affecting, e.g. an image of a heart being cradled in a lover’s hands or a picture of a lighthouse beacon guiding home a ship. In brief then, the centres of balance are dynamic elements within the space at the interface, although both are intertwined and between the polar positions. The recognition and use of such components will lead to balance and imbalance, accordingly. This may be similar to what others have termed the analytic process (Symington 1986). Sometimes these areas are defined clearly, but at other times they are nebulous or untouchable, feelings of vagueness or little understanding. When the group has difficulty in processing, metabolizing, analysing and understanding, this may lead to negative polarization; this is seen in many forms: isolation, scapegoating, idealization, manic defences, flight, premature stoppage of therapy and intransi-


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gence, to name but a few. On the other hand, positive polarization can be viewed in homogeneous groups such as Alcoholics Anonymous and Weight Watchers. Such polarization is more difficult to simplify in respect of group analysis. However, positive polarization may be seen when one member successfully completes therapy. This individual carries the hopes, investments and parts of others, which transforms into a positive pole.

Role of group analyst One of the main tasks for the group analyst is to assist the group to stay with the conflicts incurred while accessing the meaning of the interplay between polar positions, opposites and disharmony. The group analyst acts also as a central point (pivot) of balance, which at times other individuals and the ‘group as a whole’ will do. Recalling Foulkes’ basic tenet of the orchestra being similar to the group, the group analyst must immerse and direct at the same time within the cacophony of the group’s sound and music.

Encounter and alienation I presented my views on encounter and alienation in a paper I presented at the tenth Annual Congress of Psychotherapy (1992) in Amsterdam, Netherlands. This paper built on the movement through opposites and polarities, which I trust has been clear so far. With the focus on encounter or alienation, I made similar postulations on opposition, polarization in the use of the pivotal word ‘or’, the binding and separating aspects between the two positions, and the balance of tensions between the two poles. However, such concepts (encounter and alienation) have larger social consequences, particularly in respect of alienation. Transactions between individuals in groups may be seen as an encounter (often interpreted as confrontation), whether positive or negative; or alienation can occur. Becoming part of the whole-group functioning may be desired, but individuals may feel lost if they can’t succeed, that is, lost in the shadows, not recognized as special, or their individual artwork is overlooked or not spoken about in the art groups. There are also differences between techniques for art therapists working group analytically and those who are led more structurally or concretely. For those who use ‘individual in the group’ approaches, this may create an encounter between the therapist, the patient and the concrete image. There is then a potential for alienation of other group members and one may see an alienation of the group dynamic field of reference. In trying to define an inclusive theory that contained encounter

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and alienation rather than encounter or alienation, I stressed the importance of the group’s internal space (similar to my earlier comments on space at the interface and centre of balance). Here, we elaborate the use of the space between the participants, conductor, visual imagery, language and dynamic interactions (see Figure 8.11). In an earlier, unpublished paper, I stated: Within our group analytic art space, or matrix, one can see clearly the opposites either in harmony or raging against one another. For example a powerfully violent image will emerge from one person while another places a small dot in the centre of his/her paper. This could be paralleled with violent encounter and an alienated dot, but each has their own special power and components of the opposite pole within it. In the verbal group this may be experienced as a verbal tirade from one member while another cowers in silence. However, in the verbal group such dynamics may not be as immediate, needing more time to percolate through. When they eventually do they may be more difficult to contain and explore. (McNeilly, unpublished work, 1989).

I have often found a stronger pressure while working with art groups compared with primarily verbal groups. If powerful destructive imagery is displayed, the tensions thus generated can make the encounter resemble war or psychosis. The conductor’s baton does not feel adequate enough in order to deal with the potential flight into alienation. Contrarily, the imagery may have a visual resonance that heralds a positive encounter, thus minimizing alienation.

Love and hate What more powerful feelings are there that express encounter and alienation? There are strong push and pull aspects of love in the attraction of opposites. The love binds together, and the hate pulls apart. A centre of balance is achieved through love, while imbalance dominates the dynamics of hate, although one may feel imbalanced in a love state. Love is often seen as the opposite of hate. When evidenced in groups, hate may be seen as more tangible than love. Art groups show both aspects more concretely. Love is seen as more nebulous and searching for unification; it is a feeling of goodness. Hate is aimed more at destruction of the object; it is regressive and manifest in extreme feelings of badness. Thus, the imagery is so direct at times that it holds our attention, with little room for incorrect interpretation. Sayings exist such as ‘Love and hate are both sides of the same coin’, ‘Love


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and hate are a double-edged sword’, ‘There’s a fine line between love and hate’, which illustrate the immediacy of impressions. The concept of possession, similar to my earlier views on immersion, is a key feature in this dynamic system. When love and hate, either separately or in conjunction, are experienced, this may be akin to feelings of possession. One is possessed by a greater force in the interface and interactions of one and the other. Here, the dual concept of ‘we’ becomes a dominant force (Goldstein 1963). The need to keep separate such forces gives a feeling of safety. With love, the desire to eliminate opposition is in play in order to create the perfect union (or ‘we’). With hate, the ‘we’ is attacked and opposition is strengthened. One can feel ‘love-sick’ or ‘sick with hate’. Love may be seen as the ultimate in desired encounters, while hate dispels relationships, creating negative alienation and polarization. For both positions to be achieved, much logic is abandoned, and there is often a feeling of little control, i.e. being possessed. It is not uncommon for people to fall in love and for this, eventually, to turn to hate. Possibly, the hate dynamic was dormantly present as an opposing, silent force within the love search. In the hating stage, does the love no longer exist, or is it a statement of desires and hopes not being met, as were ideally envisaged? We may see a link between love and hate, as compared with there being two differing states in opposition. It is common to hear ‘I love him, but I don’t like him’ and ‘Just because they’re your relatives doesn’t mean you have to love them.’ I trust that these ideas fit into the overall framework of polar balances. As you will recall from the group analytic art therapy definition, I am concerned with everything that occurs in the session; the image-making is but a part of this. Therefore, when looking at the processes and interdynamics in art groups, if we are aware and make use of the points I have raised, this will assist us and our clients to have a fulfilling and therapeutic experience. When our focus is moving continually from polar positions, e.g. individual/group, encounter/alienation, love/hate, opposing forces and the attraction of opposites, then we are in tune with a group analytic situation. Often, these dynamics are extremely pronounced in the art group, making these intricate processes more concrete. Theoretically, where do we stand? I hope that what I am offering is a theoretical model in itself, but it owes its original debt to Foulkes and the psychoanalytic/object-relations movement. I am sad to say that it owes little to conventional art therapy literature, particularly that of our forefathers. Further theoretical exploration on the combination of Foulkes’, Jung’s and

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Winnicott’s theories would be fruitful. Winnicott speaks about play in therapy and the transitional space where creativity is formed. With this in mind, I draw the reader’s attention to the ideas within this text on centres of balance and the space at the interface. Although Foulkes is reputed not to see group analysis as an object relations theory, my own view is that there are clear indications of it being a model of object relations in groups.

Conclusion Throughout this book, I have spoken about various points in which group analytic art therapy converges and diverges with group analysis. As a way of linkage to the remainder of the book, I have compiled a comparative component list that should assist practitioners to gauge where they can, and cannot, work group analytically.

Convergence and divergence in group analysis and group analytic art therapy START OF SESSION

Art group: A basic verbal instruction is given at the start of the first session and to new members entering existing groups. With subsequent sessions, no instruction is necessary. Verbal group: Although no verbal instruction is given, there is an assumed guideline that people speak about whatever they want. Art group: Blank sheet. Verbal group: Silence.

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These are equivalent

Art group: Making the first marks. This part I have equated with classic free association. Verbal group: First person speaking. Art group: Concurrent painting/drawing, etc. (may be talking at same time). Verbal group: First speaker ® concurrent listening ® consecutive speaking ® circular speaking and listening. Art group: Some members are painting or drawing; others having difficulty in getting started or decline to start.


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Verbal group: Some members speaking; others struggling to get started; others struggling to make sense; some holding back. Both: access to spontaneous potential. Art group: First marks lead to formed images and whole pictures. At this stage, it’s an individual (in the group) process, except in group collective painting. Verbal group: First speaker leads to more than one speaker. Single sentences lead to whole stories; lead to multiple stories; mental group pictures emerge.

Middle of session Art group: When people come to the verbal circle, there is a concrete move from image-making to sharing, from non-verbal to verbal. The energy used in the image-making is now harnessed and placed to one side. There are now varying lengths of silence (seconds to minutes), in which people look at one another’s pictures before talking begins. It may be especially difficult if the pictorial imagery is intense or primitive. The access to primitive processes is often more immediate in the group analytic art group. This, in turn, taxes the group and the conductor’s abilities. The art group then has to work doubly hard, as it has not had the length of time the solely verbal group has had in order to create a verbal network. However, the pictorial impression can also be a great asset in bridging these stages. Often, what is more visually clear is easier to grasp than the elusive thought in the verbal group. Verbal group: Symbolism, imagery and colour have to be experienced primarily through language. Individuals are faced with trying to make their own transition from their internal imagery to incorporating that which they see of others, to beginning to talk and communicate with one another. The equivalent here can be compared with gear changes in a car. The communication is increased verbally; the initially separate words and statements are beginning to form ‘group as a whole’ thinking and structure; the dynamic matrix is becoming clearer.

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Closing stage Art group: With the closing part of the session, the same dynamics as in the verbal group are occurring. However, I would postulate that the added dimension of the imagery gives more substance to this area. As well as dealing with the verbal interaction, there are fixed images and symbols, which may assist in making more sense when compared with the sole reliance on words. Bearing in mind the verbal group’s session end, people are sent away with only their memory of what was said and experienced; the art group sends people away after having experienced fixed imagery within a moving group analytic experience, which may also be made more concrete if people take their images with them. Verbal group: In the closing section of the session, the group is using language to make meaning of what has gone on for 90 minutes. This will include the ventilation of thoughts and feelings, which may bring mental pictures (images), which can be held on to only precariously in many instances. However, strong evocative experiences will hold and will have an invisible quality. The closing stage is the outcome of a more seamless procedure.

Chapter 9

Openings

I hear an echo from inside. It tells of never-ending heartbreak. Brady (1999, ‘Help me to believe’) This opening line is taken from a song by Irish singer–songwriter Paul Brady. This is not dissimilar to Foulkes’ views of the neurotic symptom mumbling secretly to itself. The ‘echo from inside’ resonated with me as something moving deep inside, while trying to find an opening, a way out. With this in mind, I hope to expound on the dynamics of movement from one state or position to another. I have used the simple title ‘Openings’, as this was the first word that came to mind while trying to grasp diverse issues: a simple pivot in a complex field.

Resonance and intuition Until now, I have spoken about resonance at various points, but I have not yet connected this in any detail with intuition. In addition, I will attempt to show that there are two further points to be considered: dynamic silence, which I align with resonance, and wisdom, which I align with intuition. There have been many times in my life when I was dominated by intuition. Those feelings were almost impossible to define intellectually. Another way of saying this was that my instincts were telling me something that my head either disagreed with or found it hard to keep up with. I think it is the wisdom of my intuition that is returning when I try to reclaim the simplicity (developed later in this chapter) in psychotherapeutic methodology and theory. How many times have therapists had the feeling that something was happening with one of their patients, perhaps when they were on holiday, or 153

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felt concerned but for no clear reason? A client of mine has a dissociative identity disorder. Approximately six months before she finished therapy, I made a note: ‘I feel they [different personalities] are all queuing up to say goodbye.’ Four months later, this was what happened.

Basic hypothesis Foulkes drew our attention to resonance by describing how groups reverberate to particular themes or events. My addition to this is that I believe that there is a deeper level that is dynamically silent. This then shows itself later in the group as a formation of resonant associations. In the verbal group, this is evidenced by what is said and what is conveyed non-verbally. In the group analytic art group, this has the added ingredient of concrete imagery in pictures and three-dimensional objects being produced. Intuition is spoken less about less in group analysis, although Jung gives it a lot of attention. Intuition, I suggest, is wisdom without words. When our intuition stirs, I believe it touches, and is touched by a deep sense of wisdom that has been built up over many years. Young people may be in touch with it through their creativity, simplicity and spontaneity. Is the expression ‘Out of the mouths of babes and children’ a description of pristine wisdom? I also suggest that one key element at the root of resonance is intuition, a result of our life experience enabling us to ‘know’ when something is right or wrong. When trying to find a bond between intuition and resonance, this is a little more difficult to understand and realize. When an event or dominant feeling is in operation in the life of the group, this reverberates within each individual. As well as touching conscious associations, it also stirs intuitive feelings, which in turn resonate on this deep level. The wisdom of the intuition will then play a part in deciding what is released, or not, into consciousness as the shared resonance of the group. The simple phrase ‘It touched me’ gives some language to such a process. This often has the appearance of the group not knowing why something shifted in such an emotive way and either brought the group together so clearly or threatened to push it apart. Although most people may be in harmony in such a process, one or more may appear not to be touched and seem removed from the proceedings. This may be because their intuitive feelings were not touched on that particular theme, or their deep wisdom is protecting them from the resonant associations. One outcome of our various analytic trainings can be a discouragement or diminishing of our intuitive faculties. Kottler and Blau write:

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Beginners, in their insecurity, seek supervision and advice on how best to work with their clients. They attribute weight and significance to the suggestions of their mentors and eagerly try to implement them. For in their desire to find the answer, to help their clients resolve their concerns, they sometimes do not heed their own intuition. Indeed, many beginners admit: ‘I fail when I’m not true to myself ’. (Kottler and Blau 1989, p.86)

Resonance Foulkes developed his original views, first published with Anthony in 1957. In his early publications, I found that Foulkes had spoken about resonance being primarily instinctive and, therefore, within the realms of the unconscious. This gives some credence to my own formulations, linking resonance with intuition. Foulkes writes: The term resonance was originally introduced by me in the field of group-analytic psychotherapy in order to do justice to the fact that each individual member picks out of the common pool that which is relevant to him. He responds according to his individual disposition on the specific level of regression, fixation or developmental arrest on which his main disturbances and conflicts operate. This unconscious highly specific reaction in response to a stimulus is roughly what I have called Resonance… There is, however, another much more significant feature of the process of resonance which perhaps can be seen more readily in the group situation. It is this: the ‘stimulating’ event can take any conceivable form or manifestation. Apart from verbal communications, the unconscious meaning may be expressed in behaviour, in somatic events, in accidents through dramatic developments in life, in the boundary zone of the therapeutic situation and in the network or plexus to which the patient belongs, or in any other way. Though we have been treating this process in terms of stimulus and response, resonance is a good example of communications taking place without any particular message being sent or received, being in fact purely instinctive. (Foulkes and Anthony 1984, pp.298–9).

Resonance within the foregoing schema is understood and explained by consecutive language, i.e. unconscious impulses and reactions to this. In the group analytic art group experience, there is a primary concurrent expression of resonance (while concrete imagery is created) as well as consecutive

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expression in the verbal section of the art group. This has been written about by Roberts. The clinical examples he uses are taken principally from groups that I conducted. He says: ‘This paper draws attention to a phenomenon which occurs surprisingly commonly in art groups, and the explanation for this is not easy. Remarkably, while the individuals in a verbal group contribute to “resonance” consecutively, in an art group they contribute concurrently’ (Roberts 1984, p.211). I believe that Roberts is conceptualizing this horizontally. In my paper ‘Group Analytic Art Therapy’, I stated: As each group becomes accustomed to this way of working [group analytically], self-disclosure becomes less threatening, with people relating more to their feelings and the images they have conjured up. Resonance manifests itself more and on a deeper level. Personal initiative becomes increasingly evident. (McNeilly 1984, p.206)

On reflection, I think it was my intuition that was drawing together deeper levels of resonance with personal initiative. In this book, I suggest that it is personal intuition that creates this more direct channel for resonance to be evidenced. The following may simplify this: 1. Individual creativity and space are opened up, allowing group members to form concrete imagery. 2. The spontaneous creation of visual imagery touches (resonates) instinctive intuition in symbolic form. This is in the usually silent image-making part of the art group. 3. The following verbal part of the group brings interaction, which facilitates resonance on, primarily, the consecutive level, while incorporating the previous concurrent expression within the image-making production. 4. The underlying intuition that drives and brings this about becomes more tangible.

Intuition David Smail writes eloquently about intuition: Our objective habits of thought also demand that some account be given of what could possibly be meant by ‘intuitive sensitivity’ – for example, on what objective or mechanical structures could it depend? Though I certainly mean to invoke no mysterious or magical faculty, and

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while I am happy to acknowledge that the exercise of such sensitivity must depend on the structures of our body and the evidence of our senses, it does seem to me that perhaps it cannot be analyzed in the way which objectivity demands, since it lies at the very basis of our knowledge of the world. (Smail 1984, p.151)

You will recall my earlier description of intuition as wisdom or knowledge. Jung speaks of intuition as one of man’s four psychological functions: Intuition is an unconscious process in that its result is the irruption into consciousness of an unconscious content, a sudden idea or ‘hunch’. It resembles a process of perception, but unlike the conscious activity of the senses and introspection the perception is unconscious. That is why we speak of intuition as ‘instinctive’, an act of comprehension. It is a process analogous to instinct, with the differences that whereas instinct is a purposive impulse to carry out some highly complicated action, intuition is the unconscious, purposive apprehension of a highly complicated situation. In a sense, therefore, intuition is the reverse of instinct, neither more nor less wonderful than it. (Jung 1960, p.132)

Let me highlight Foulkes’ comments on intuition: It happens not infrequently that one’s actions, interpretations, timing in the group session itself are on an intuitive basis. This is as it should be – what is important is to think later, in the interval between sessions, carefully and thoroughly about the group and about this type of intervention. (Foulkes 1990, p.220)

Kottler and Blau make some interesting points in respect of new therapists and align this to wisdom: Like a compass, there is an inner sense that helps point the therapeutic direction, yet many neophytes ignore what these voices tell them. They are launched out of the present and caught upon pleasing the referring professional, the court, the client’s family, the probation officer, a colleague. Visions of accolades and promotion fill their imagination. With applause ringing in their ears, they march ahead without consulting their most important resource – their inner wisdom. (Kottler and Blau 1989, p.86)

I feel that Kottler and Blau are inadvertently calling intuition an inner wisdom.

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Peter Lomas speaks about wisdom and intuition back-to-back. I do not know whether he inferred a link between both, but by presenting them together he implies such a link. His views parallel many of my own. Regarding wisdom, he says: The quality that is most needed is, I believe, best denoted by the word wisdom whose dictionary definition meaning is ‘the capacity for judging rightly in matters relating to life and conduct.’ Unfortunately, the introduction of this concept is liable to bring conversation to an end, for what can one say about it that has not been said by those before us, in ways that we could not expect to better? It is, in fact, rather easier to describe what it is not. It is not for example, adequately portrayed by a contemplative and immeasurably contained sage sitting comfortably in his chair giving forth measured responses, for on some occasions, with some patients, it may be more appropriate to dance around the room or cry. (Lomas 1993, pp.17–18)

Under the heading ‘Intuition’, Lomas writes: Much of the art of therapy depends on being able to place oneself within the experience of the other and to feel, in some measure, what it is like to be him… The word that I use for this capacity to empathize is intuition. Like many words it has a chequered career, having sometimes been regarded as an attribute confined to angels, but I shall use it to mean simply ‘direct or immediate insight’. To say this does not, I believe, imply that such an ability is distinct from cognition or learning, but that it is achieved without a conscious awareness of a logical process or the application of theory. Intuition, therefore, should not be regarded as a magical gift that has nothing to do with thought or experience of life and that it is intrinsically inexplicable. It is more likely that at the moment of gaining insight, we are quite unaware of the steps that led to our knowledge. (Lomas 1993, pp.18–19)

In brief, therefore, the links that I have made between resonance, intuition, simplicity and wisdom should be seen as a dynamic interplay that moves in a circular weaving manner, deep within vertical and horizontal presentations. I feel it would be a mistake to take each of the words ‘resonance’, ‘intuition’, ‘simplicity’ and ‘wisdom’ as a separate description of such a complex underlying phenomenon.

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Illustration The following illustration gives substance to the points I am postulating. Although the first group is composed of students and is primarily verbal, I believe it creates a rich, visually symbolic field. I recall many art groups that produced similar concrete symbols in their pictures.

Student group As I came into the room, the group members were sitting in a V-shape with a chair at the opening of the V, which I sat in. A brief silence was followed by laughter and then a comment about envisaging this happening when I come into the room. Quickly, the session reflected back to last week, with one person, who had been absent, wanting to know whether it was OK to ask what had happened. Then they spoke about the struggle between men and women. There was an early comment about the analytic process of the group, with one woman speaking about analysing people’s shoes. Before I came into the room, they had spoken about liking my shoes. This was a trigger for the later resonant associations, which were initiated by the first person, the one who was absent last week due to her father’s death. She spoke of things coming up for her in the group that couldn’t be kept out; this was linked to facing me (she was at this point of the V, with me at the base in the seating arrangement) and seeing my shiny shoes. She began crying, saying that this was one of the things she remembered about her father, i.e. his shiny shoes. This was echoed later by another woman, who spoke of her mother beginning to talk about her husband’s (the woman’s father’s) death and also remembering her grandfather’s shiny shoes. In parallel with this, the woman whose father had died was holding a stone given to her by another woman who also related her story. This was linked to events in the past week and forgotten memories from childhood when she was nine years old. At this point, there was a development of resonance on bereavement with silent associations. A gradual development of verbal associations brought the resonant imagery to the fore. The image of the stone is also interesting: the woman who gave the bereaved woman the stone spoke about the previous week, outside the group, when she did not get a job she had applied for and how she allowed herself to feel angry and upset. In last week’s session, she was denying the conflict in not getting work in the past. One evening, she had gone to bed and woken up at 3 a.m. When she went downstairs, a man was knocking at the front door. She went into a regressed state, calling for

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her husband, who came out of the bedroom in steel-toe-capped boots in order to sort out the crisis. This brought back the forgotten memory of when she was nine years old and her house was broken into. She was with her mother, and the fear was the same as with the present crisis. I would suggest that the deep origins of knowledge had been activated by the present attempted break-in, which sparked off a resonant chain of associations individually for her, reverberating with the past and present within the group. In return, each person was then resonating to these two focal aspects of bereavement and fear of intrusion. Regarding the stone, both women connected to it within the group. The bereaved woman said she would ‘hold the group’ tomorrow at the funeral of her father by holding the stone during the ceremony. In a later interpretation, although I also made others, I highlighted the power of the stone that takes a long time to develop and never dies; this would be similar to relationships growing, developing and being held in one’s memory after loss and death. In my interpretive comments, I looked at the projections of power on to me at the beginning, the powerful components of denial, the power of forgotten memories that are released once the defences are set aside, and, most significantly, the power of the imagery that had been created through the association both with the shoes and with the stone. Therefore, in keeping with my theoretical hypothesis, the stone would be equivalent to intuition and knowledge and the shoes are the surface triggers for resonance. Both images linked together draw our attention to security, for instance the religious analogy of Saint Peter being the rock on which the church is built and the shoes being linked to parental figures. If one draws a parallel in an art group, one could imagine such images being painted and drawn in picture format or created in three-dimensional materials, which I would suggest may well have the same impact as the discussion in this particular verbal group analytic group. Although the art group would be starting with the creation of concrete imagery, it would not be uncommon to have dynamics and pictures similarly constructed. Members may well refer back to previous sessions and paint or draw images of shoes, stones, coffins, funerals or houses being broken into; these, in turn, would bring dialogue, which would resonate accordingly. However, it is impossible to draw an exact equation, as other symbols portrayed may become more prominent in the foreground. In a similar way, another verbal group may produce the same focal imagery and yet go on another track.

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Complexities – subtleties – simplicity There is a song by Van Morrison (words by Peter Handke) called ‘Song of Being A Child’. What inspired me about it was the simplicity of the prose, which also conveyed subtle and complex language. It moves back and forth from the child to the adult, and that which changes or does not. Here are two verses: When a child was a child It was the time of the following questions Why am I me and why not you Why am I here and why not there Why did time begin and where does space end Isn’t what I see and hear and smell Just the appearance of the world in front of the world Isn’t life under the sun just a dream Does evil really exist in people Who really are evil Why can’t it be that who I am Wasn’t before I was And that sometime I, the I, I am No longer will be the I, I am. (Handke and Morrison 1987, 1998)

This song shows how the complexities of human development changes are conceptualized. It also shows how we saw things as a child differently from how we see them as an adult, the latter perspective at times appearing more complex. However, it is in childhood that we do much of our processing of complex or complicated psychological developments, probably not realizing we are doing it. This is often achieved through spontaneous or planned play, creative expression or art-making, as just some examples. In our acquisition of adult skills and intellect, we lose a great deal of the simplicity of childish ways of thinking, intuition, being with others, play; if rekindled, this simplicity would serve us well. In an analytic group session, I said at the end: ‘How do you eat your Mars Bar?’ as analogy to the complexities involved in savouring the moment. That question, like many I have used, was a spontaneous one that took me back to my childhood days of eating confectionery.

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Hypothetical structures The field of presentation and understanding of complexes, subtlety and simplicity is great, and I can only touch briefly on these aspects. A complex is a combination of components in a structural format that enables us to conceptualize thinking. This also helps us to understand the complexities of symptom formation. Laplanche and Pontalis define a complex as follows: Organized group of ideas and memories of great affective force which are either partly or totally unconscious. Complexes are constituted on the basis of the interpersonal relationships of childhood history; they may serve to structure all levels of the psyche; emotion, attitudes, adapted behaviour. (Laplanche and Pontalis 1983, p.72)

In contrast to a complex, subtlety is an almost invisible, hidden, circuitous arrangement that, at times, appears to hit the mark or capture a psychological mechanism or interaction. To be subtle is also connected to being careful, but at other times it may be interpreted as being devious. The expression ‘an iron fist in a velvet glove’ comes to mind. Let me now speak about simplicity – the process of making simple or less difficult. To find the common ground between complexity and subtlety is to see simplicity as a pivotal point. Paradoxically, psychotherapy is both a complex and a simple therapy. Existing theory ranges between the complex and the simple, but more often the former. I am drawn to finding simple structures of understanding and intervention within the therapeutic frame. I believe that this is possible only if there is a firm grounding in more complex theory. The simple psychotherapeutic interpretation draws upon historical roots of theoretical complexities and the appliance of direct and subtle presentations. Before focusing on the art therapy side of things, let me illustrate the triangular configuration (complex, subtlety, simplicity) in my primarily verbal psychotherapeutic work. A patient I see for individual psychotherapy said to her lover: ‘How can you live the rest of your life without me in it?’ The patient was seeing her lover’s life as being empty in the future but full of the loss of her. This is a complex situation, which, when expressed in this way, carried a subtle but powerful impact. The actual question is also simple. Possibly, the power of the question rests on the triangular construction of complexes, subtlety and simplicity. In a later session, she appeared to have an almost malignant intransigence in holding on to her lover for ten years in the resistance to letting go, while emphasizing that she wanted to change the

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situation. A simple interpretation came to me: ‘Love has blinded you to the tactileness of logic.’ I said this before I thought about it. There was a simplicity about it, but there was also a subtle mechanism of linking many elements between impulses surrounding love and the battle with logic on many levels of the patient’s life, which were indeed complex. In my interpretation, I was accommodating the abstract, illogical, incomprehensible conflicts of love in contrast to the elements of logic, which, if acted upon, had a tactile formulation. The simple evaluation of art expression within a therapeutic frame is paramount to a curative factor, in the same way as art expression for the child is paramount to psychological or emotional growth and is of overall merit. Therefore, whether it is individual art therapy or group analytic art therapy, it is the production of art imagery that is a basis for change and growth. The added dimension of verbalization is part of the process. When people come to us as our patients, the central aim will be to help them to get in touch with themselves through the process of therapy and to reach a point of change and alleviation of symptoms. This, at first, may appear to be a complex process. However, it may become difficult to achieve succesful therapy if it becomes unnecessarily complex. On the other hand, if simplicity and subtlety are accessed then there may be greater success. Simply speaking, if, for example, one sees the movement from a single dot being made on a piece of paper towards more complex imagery, this may be reflective of the struggles from an isolated position to one of socialization. Likewise, the creation of a circle seems simple, but the ability to produce a circle is a complex although basic skill that emerges in childhood. The difficulty in creating circles in later life may be a reflection of difficulties in establishing harmony or fulfilling relationships. A question mark arose in one of my art group sessions where the central theme was connected to struggles with wholeness. In this situation, the notion was that a question mark was a circle that was difficult to complete. Here, a completion of a circle was not achieved. There were other expressions of abstract formations along with highly structured images. This took us into the area of the complexities within control or the fear of being out of control. Each symbol formulation had many variables and derivatives, reflective of the complexities of human meaning and interaction. There is a movement between the individual expression of imagery and how this portrays the complexities of the situation, along with the subtle implications and how these are expressed and worked with.

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According to what each patient brings to therapy, there will be a variance in the complexities of the imagery that they produce. Many patients I have seen for individual and group art therapy have expressed both simple and complex images. Depressed patients often produce imagery that is dark and formidable; anxious patients spiky and unpredictable images; suicidal patients frightened and pessimistic images; borderline patients fragmented imagery; narcissistic patients imagery in which they are the centre of the world and with a fear of annihilation; patients with eating disorder presenting distortions of the self, to name but a few. With all of these patients, the production of artwork had taken on a different meaning for each. In practice, the methodology is the same. However, initially, as each person enters the therapeutic session, there is the simple expectation that they produce a pictorial image without a thematic expectation. There is a progression through these stages from an initial mark-making (or difficulty in doing so) into the interchange between complexes, simplicities and therapeutic subtleties. For each one of these schemas, the movement and resolution within the triangle may take many months or years. The position of a person who is disabled or disturbed due to their condition has a complex history and may not be moved by the production of artwork – as was looked for in the older way of art therapy, which laid great store on the healing capacities of the art activity. It is the combination of the primacy of art expression, the verbal use and conceptualization of meaning, the use of simplicity and complexity of interpretations, and the subtlety of therapeutic approach and intervention that will assist resolution and change. In conclusion, I hope that I have clarified the intricate interplay between the dynamics of complexity, subtlety and simplicity. I have attempted to show that there is a triangular framework and interplaying network that holds and binds together these elements. The complexities of psychotherapy and art therapy are profound, but it is in the simplicity and subtleties of our approach that the complexities can be understood fully and worked through. Art as therapy offers a starting point – the making of simple and complex images on a blank piece of paper. Although parallelled with the first words uttered in the silence of a verbal therapeutic session, art therapy maintains the potential for evocation, possibly primitive, of thoughts and emotions, which can be graphically representative of complexity, subtlety and simplicity.

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Psychotic openings Psychosis is a complex condition that may appear unfathomable. Beyond the area of dissociative disorders, which may be considered psychotic by some, I have little working knowledge. However, what I present in the closing part of this chapter are presentations within groups that are analogous. I will consider the interplay between the neurotic and the psychotic-like experiences and expressions as seen in the group analytic art group. When we describe the different diagnoses and categorizations of the patients we work with, we tend to describe the presenting symptomatology within a psychotic or neurotic framework. With psychotic patients, this is more the domain of psychiatry and the symptoms imply mental illness. With neuroses, this is more clearly described within a dynamic formulation built upon the meaning of symptom formation. This tends to be the domain of various forms of counselling and psychotherapy. The old term ‘borderline psychosis’ at one time held together these two worlds, but in recent years, with the sophisticated approach to personality disorders, advanced definitions have been developed: Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) personality disorder clusters A, B and C. These separate and potentially reduced descriptions are not rigidly fixed. There are neurotic and healthy parts within the psychotic, and psychotic thoughts and experiences within the neurotic. The personality disorders straddle both the psychotic and neurotic, and the so-called normal, sane person also has experiences that are akin to these extreme positions – be it when they are awake or during sleep in the form of dreams. So, instead of saying that a person is a ‘psychotic’, a ‘neurotic’ or whatever, we should see him as a person who struggles with the condition. I describe the line between the various conditions as an ‘opening’. I shall address the openings within a group analytic art group that came into being at times in the life of groups. As well as these being critical and frightening moments, there was also a creative and healthy shift in the need for the opening to occur. Such times and events were essential in the mobilization of change. Such openings have often taken off particular therapeutic blinkers, allowing us to see anew. There are many varying causes of and reasons for psychological problems and illnesses. Psychiatrists, psychotherapists and psychologists have differing opinions as to whether these causes are genetic, biochemical, psychological or sociological. In the world of psychosis, particularly schizophrenia, many practitioners are drawn to the genetic, which can also be

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applied to the area of addictions. Within the wider field of neurosis, personality and relationship problems, practitioners generally move into the area of psychological meaning and formulation. Therefore, psychosis and schizophrenia are often seen as incurable (with the exception of psychotic-like episodes) and are controlled with medication. Although medication may be used for neurosis, it is seen much more as an ‘illness of events’ and solved through exploration and resolution. Considering these positions, we are a step closer to seeing the potential for openings to occur and to gauge elements that can lead to various levels of healing while understanding the dynamics that are woven throughout. Although there is a general debate on causality, I would postulate that no one is born neurotic or psychotic. In my original lecture, when I presented my paper on ‘psychotic openings’, I asked the audience to close their eyes and imagine a person whom they knew who had some form of psychological difficulty or problem that had made an impact on them. I asked them to imagine what they were like as a child playing or in some happier circumstances in order to help them look beyond the illness or condition, to see someone like ourselves when we were children, before they became an ill acquaintance, friend or patient.

Theoretical perspectives By its definition, psychosis is seen as a lifelong and enduring illness within British psychiatry. People with depression are often told to ‘snap out of it’ or ‘pull yourself together’. Such people are described in some areas of society as malingerers or ‘the worried well’. The boxer Frank Bruno was described in the headlines of a newspaper as ‘Bonkers Bruno’ after suffering from severe depression. Previously he had been seen as a British hero and world champion boxer. In my clinical work setting, an audit showed that the average length of time during which our patient group struggled or suffered with their condition was 14.2 years (not including psychotic clients). If this is not long and enduring, then I do not know what is. In Britain, the term ‘long and enduring’ is reserved for the psychotic population. In our professional fraternity, there are strong divisions in classification and understanding – doors are closed more often than openings being created. Foulkes speaks eloquently of the variants within normality, neurosis and psychosis. I see his comments as early descriptions of what I call ‘linear referents and openings’. He says:

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The basic human problems with which psychoanalysis is so much concerned I therefore see as being more transmitted than inherited, although the two are never water-tight and apart. Complicated emotions can be felt even by the small child as they are actually represented and transmitted, however unconsciously, by the parents, brothers, sisters and so on. These norms and values are engraved in the individual; they form his ego and super-ego from the beginning and are of incredible strength. I believe that psychotic mechanisms are operating in all of us, and that psychosis-like mechanisms and defenses are produced very early. This does not mean, however, that later psychotic illness, later psychotic disturbance is a regression to these early stages, as one might say that neurosis or neurotic reactions are. (Foulkes 1990, p.276)

The individual position From this point, I shall refer to my groups as neurotic as a form of shorthand. There are times when individuals face points of crisis or conflict within the norm of the ‘group as a whole’. As stated earlier, Foulkes has described the individual as a nodal point within the group network. So, by definition, such individual changes can either be an outcome of the whole group or affect the whole group from the individual in the foreground. In keeping with the central thesis, individuals can open up particular areas to the whole group, with the outcome that the group is psychotically disturbed to varying degrees, either with individuals being more or less affected, or the ‘group as a whole’ identifying in a fragmented or psychotic way, or both. There is a potential, then, for the group to open up by falling apart, in the worst scenario. A sequence of events can be described. 1. The individual starts to get in touch with repressed or forgotten memories. 2. Individuals’ repression barriers are lifted, leading to unconscious flows of association and regression. 3. Life issues that are contributing to the breakdown outside the group lead to heightened fragmentation and disintegration. Here, the ‘group as a whole’ may become psychotically split between reacting internally while feeling powerless to affect external change.

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4. The individual becomes paranoid in respect to either group members or an outside situation. This can then open up paranoid tendencies, or the paranoia may develop in the ‘group as a whole’. 5. Individuals with rigid personality structures who have difficulty changing may dissociate from the work of neurotic struggles for meaning and resolution. This leads to an almost psychotic feedback. The individual holds fast to his rigid position (possibly a defence against his own psychotic breakdown), which mobilizes into psychotic potential where the ‘group as a whole’ feels potentially ‘mad’. Such stuck or rigid positions may be expressions of individuals with deep depressions, morbid jealousy, severe narcissistic personalities, severely schizoid positions, ‘help-rejecting’ (common terminology for people who complain and nothing seems to help them) traits or passively aggressive traits. With this latter position, the group may identify with either side, leading to a psychotic-like split or opening between passivity (intransigence/fused) on the one hand and aggression on the other. 6. Individuals may disclose particularly sensitive material in the group, e.g. abuse, murderous or suicidal feelings, statements on extreme deprivation, disturbing dreams or fantasy life, or eating disorders that are spiralling out of control and becoming life-threatening. Once again, the individual’s extremely disturbed and apparently psychotic structured thinking is released into the whole group. Each person resonates to the complexities and identifies neurotically (conflictually) or psychotically (fragmentedly). These are just some of the many points. However, every group is unique, and how such openings are dealt with depends on each particular group. These openings can move the group into healthier and creative outcomes if they are dealt with properly. Further openings are not then seen as so difficult or threatening. On the other hand, openings can lead to further breakdown for the individual and the ‘group as a whole’. At such times, the psychotic openings have moved the whole group into a psychotic-like state, potentially leading to disintegration of the group.

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The group as a whole In considering such openings from the point of view of the ‘group as a whole’, a new thought emerges. Even when looking at the points I have raised in respect of the individual, he is still the individual in the ‘group as a whole’ who is expressing himself. However, we semantically separate such constructs in order to examine differing perspectives. Bion (1961) helps us to understand the psychotic potential of groups, particularly large groups and groups that do not have a clearly defined leader, i.e. the group will pick its most disturbed individual to fill the leaderless gap. This seems to imply an opening of the psychotic potential that has been released in the absence of a formal leader (Bion 1961, pp.121–2). In a similar way to the earlier individual categories, let me highlight some group-specific aspects where openings occur: ·

The group experiences an existential crisis through, for example: °

a natural or suicidal death of one of its members

°

a reaction of one member having a recent bereavement

°

an attempted suicide or other form of self-damage by one individual. For example, self-laceration can open up the ‘group as a whole’ barrier between each person’s internal and external worlds. Thus, inner cuts, scars and rawness may be experienced by the whole group. The group feels like an open wound. Conversely, the use of cigarette-burning as self-damage may act as a closing-off mechanism, i.e. the burn is sealing the group’s skin, even though it feels opened up in the first place.

·

The group may be overwhelmed by one individual and can feel robbed of its thinking. Thus, individual psychotic-like language and imagery can make the whole group feel mad because it no longer has meaning and is opened up to primitive impulses. Here, I am referring to extremely regressed, disturbed individuals.

·

The whole group goes through passive or resistant periods, which leads to an impasse. Thus, the whole group suffers and moves into a schizoid or autistic position, leading to a psychotic-like feeling of alienation or dissociation. The group

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symbolically fragments although looking together, with individuals moving more into their internal worlds. Thus, a paradox exists of closure and opening being combined. ·

The group goes through particularly dramatic changes when dealing with explosive individuals. Here, the levels of projection and projective identifications are high. The psychotic potential is more overt and the openings are severe between the neurotic and the psychotic. Once this happens, the whole group feels like an individual in the acute throes of a full-blown psychotic breakdown. The causes of this situation are numerous, but, like the raging genie in the bottle, imprisoned for thousands of years, once released it feels almost impossible to get it back in the bottle. Each group is unique, and although one can trace similar elements in all ‘groups as a whole’ theory and technique, one has to live in the moment of that group opening or dimension.

Mike

Patricia

Mary

Sonya

Helen

Figure 9.1 Art group illustrations.

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Let me tell you about two art group sessions. Figure 9.1 shows some of the artwork produced: Mike: Patricia: Mary: Sonya: Helen:

No concrete image. Coloured face of a teddy bear. Drawing of a face with red spots and a figure walking up a hill. Rectangular box. Seven different-coloured ghosts, with one not completed.

The illustration is taken from a session of a group that meets once a week. The clients are not involved in other methods of psychotherapy. When people came into the room, they went straight to the tables and began to make images. During this part of the session, there was a lot of jovial talk, which revolved mainly around dentists. When the group members convened in the verbal circle, the talk of dentists and teeth continued. This then became more focused on holidays, and the problems arising. This prompted dialogue with people exploring why things turned from good to bad on holidays. There was a recognition of Sonya’s box paintings reflecting feelings of being trapped in boxes. The focus then moved to Mary, who did apply a specific meaning to her picture: the red spots denoted an infection. However, the main part was the figure climbing up the hill. At the top of the hill is a wise person in a cave; this person represented me with my words of wisdom. From this point, the discussion moved back to a general dialogue about relationships with partners and seemed to be an evasion of Mary going up the hill to get away from life’s demands, thus reflecting a transference statement relating to me. When the focus moved to Helen and her ghosts picture, this seemed to open up delicate and deep feelings, not only for Helen but for the group as a whole. What seems to have been opened up for her was that the nine ghosts represented the age when she was abandoned. Gradually, people began to talk with Helen and to contain the strength of her flowing feelings, but this was to little avail as she could not stop or listen. The tension in the group rose with the others’ attempts at intercession and solution, but to little avail. Eventually, I interceded that Helen was not listening to what people were saying. With this she left the room, as she could not listen. There was a sense of shock in the group and I was asked whether I was going to get her back, but I did not respond. I felt that I needed to anchor my own thoughts.

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It was Mary who eventually broke the silence, after about five minutes. She started a conversation with Patricia on the progress of her husband’s application to join the police. Patricia went on to speak about her drawing of a teddy bear, which was a toy she has held on to from childhood. There were some associations with her picture being like a Chinese comic character who gets into mischief but never gets caught. This seemed like an unconscious link to Helen’s position. Like Helen, Patricia had not been protected by her mother, which had also been symbolized in the teddy bear. In previous sessions, it had become clear that the teddy bear symbolized Patricia’s mother’s presence. Beyond this, there was no further talk, either about the images or the impact Helen’s leaving had evoked. Eventually, Helen returned to the group, and nothing was said apart from my affirmative ‘You’ve come back.’ The group reverted to dialogue on teeth and dentists.

Commentary In terms of psychotic-like openings, this can be seen in the evocation and disclosure of the abandonment of Helen. Until that point, although the group had unconsciously been tuning into areas of pain within dentistry, the order of the group was maintained, i.e. talking of colourful stripes and boxes devoid of psychic meaning. We can see four sequential stages from the beginning of the session’s verbal section: 1. The resonant associations with Sonya’s difficulties with her holiday, i.e. internal sympathy for Sonya’s plight. 2. The dominance of Mary’s picture of a throbbing reaction to infection while trying to get away from life and moving towards me up the hill – this deeper pain is being flown from. 3. The opening-up of feelings of abandonment from Helen that heralds a psychotic-like experience in the group. Not only are there personal associations and resonances – e.g. Patricia’s own loss – but there is also a great effort in trying to contain the struggle that is broken by Helen running from the group. Thus, in line with my earlier theoretical postulations, the group psychotically fragments momentarily. 4. The opening comments after the silence that are an attempt to bring back law and order, i.e. questions about Patricia’s husband’s police application. Unconsciously, feelings flow to the mother who left the child (Helen) who was not caught. Here, there appears to be a neurotic/normative attempt to heal the

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group’s psychotic split, which is also helped by Helen’s return. She came back, but her mother did not. Also, the eventual returning to talk about dentists is a circular move towards order and, possibly, a desire to deny or undo what has occurred in the past 90 minutes. Figure 9.2 shows some artwork produced in another session: Mary: A black cage with a matchstick figure inside. Facing the cage are seven figures (note the previous session illustrated with Sally’s ghosts), one of which is separate, purple and with hands and arms by its side. This number also equates to the number in the group. Helen: A painting of a local forest area. Nine birds are flying and there are nine flowers on the hills. Mike: No concrete image. Cynthia: Purple square in the centre of the page, with different lines of colour extending from this. Sonya: No concrete image. Patricia: No concrete image. Even though Mike, Sonya and Patricia did not make images their blank pages are included. The image-making part of the session was quiet and lasted for 35 minutes. In the verbal part of the session, the dialogue opened with joking about my name. This seemed to be a way of creating a relaxed feel to the session, as Sonya conveyed a tense silence. The focus then moved to Mary’s picture of the cage. Although the number of people outside the cage reflected the number in the group, it had other points of significance. It had represented the people from her past who had tried to help her, but with little success. The fact that I was her favourite colour (person) and one who was not reaching her, but waiting, created a difference. I was seen to be in a privileged position. There then followed a silence of three to five minutes. It is possible that the development of the silence gave an opening for the three people who had not created a concrete image; now they were free to paint the group with their words. Sonya went into a long commentary on her lateness in a softly spoken way, which drew the others in. She spoke of the difficulties she was

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Mary

Helen

Mike

Cynthia

Sonya

Patricia

Figure 9.2 Art group illustrations.

having at home. As the momentum built, she became tearful, and the group was transfixed; as my co-therapist described it, there was a sense of awe. There was a speechlessness that was broken by Patricia, who began to identify with Sonya. Patricia went on to disclose the various struggles she had when she was rejected by her stepmother while maintaining a secret relationship with

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her father. Similarly, a feeling of awe in the group developed with regard to Patricia. From this point, the group moved back to some level of orderly associations, with Helen speaking about feeling a psychological improvement and Cynthia highlighting her struggles between having children in contrast to conflict in maintaining her occupation. As things evolved in the session, some cried while the others remained silent, which took us to the end of the session.

Commentary The fact that Sonya was in a distressed state before she came to the session would indicate a potential for psychotic-like fragmentation away from the normal, neurotic position of the group. In the first part of the session, Sonya, like Patricia and Mike, by not creating a concrete image, sets herself apart. However, the first verbal associations on Mary’s cage bring into relief the feelings of restriction or breaking free, along with ideals on being saved. As in the previous week’s illustration (Figure 9.1), I am seen in transference with the saviour archetype as well as being privileged. Until this point, there is a stable exploration of the various conflicts. With the movement to the silence after the opening dialogue, one of the non-concrete image-makers, Sonya, creates an opening for the more damaged and chaotic material to emerge related to earlier abandonment until she is saved. A similar thing occurs as in the previous session, with the group becoming transfixed with a sense of awe. Eventually, order returns, as in the previous session, with Helen’s talk of feeling better, the move back to normal struggles around childbirth, and, finally, tearful emotions.

Conclusion In conclusion, although I have considered quite a diverse group of subjects within this chapter, I trust the reader will have grasped the central tenet of movement within each area. As in my earlier commentary on the numerical significance of the double dual of resonance and intuition with dynamic silence and wisdom, these then form a quadrant. There is a three-part exposé of complexity, simplicity and subtlety, which can be viewed as triangular or interweaving. These constellations are moving descriptions or definitions used to explain systems in flux.

Chapter 10

Cross-fertilization

Introduction ‘Grafting’ is a more appropriate word to describe what I have attempted in group analytic art therapy, but in some ways I have cross-fertilized my ideas and techniques with a primarily Foulkesian group model. However, grafting plants seems to occur above ground level whereas much of what I have attempted is below ground. One definition equates grafting with hard work, while another defines it as an acquisition of money and/or power by dishonest means. I feel that what I have attempted has been hard work, but I hope it is not seen as me stealing Foulkes’ ideas. The deeper connections are understood more easily within the fertilization analogy. In this way, I aim to bring the fertility elements of art therapy to the world of group analysis. I shall, therefore, be going into deeper soil while expanding upon content, process and structure. The remainder of this chapter returns to the individual and the ‘group as a whole’, but in a deeper exploration than in Chapter 4. In the closing part of this chapter, there are further reflections on the double positions I raised in Chapters 8 and 9, but in this chapter I explore the idea of the dual and duality.

Content – Process – Structure Throughout this book, I have built on key concepts in group analysis and how I have adapted these to art therapy groups. A key is of little use without a lock, and certainly group analytic therapy is developing considerably. Practitioners and theoreticians are building on Foulkes’ methods and concepts within their own particular settings. As such, the process of enriching the fertilized soil, along with honest grafting, continues. This, therefore, implies that many theoretical and technical locks have been opened, but equally many wrong keys may have been used and yet more locks are waiting to be opened with respect to content and process. I could find little that dealt spe176

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cifically with this in group analysis. Foulkes saw little or no difference between content and process and viewed them as interchangeable. For example, the matrix could be seen as a structural concept with communication as a point of process. If we see the matrix as a womb or mother, it is a living concept and, as such, a dynamic process. Likewise, both communication and resonance are concepts containing structural components with solid points of reference and, as such, have a conceptual or actual framework. They are comparable to a river being conceptualized as one entity while at the same time being a combination of moving water rippling over rocks, foaming and gurgling noises, fish jumping, the sun reflecting, with the wind changing the currents. Luce writes: Plato attributes to Heraclitus the dictum that ‘all things move and nothing remains still’ and adds that he compared reality to the flow of a river, saying that ‘one could not step twice into the same river’. This is often referred to as the doctrine of Universal Flux. (Luce 1992, p.45).

Let me simplify matters. The content of any group analytic group can be described in a number of ways. These encompass the number of people in the group along with variations in membership, for instance, gender ratio, clinical condition and age, and the administrative ingredients, i.e., the structural contents of the room, ranging from the types of chair to the interior decor. In the verbal group, the process can be described as the pre-entry assessment entry to the group, verbal/non-verbal communication, and termination of an individual’s therapy or the ‘group as a whole’. The content and process of the group analytic art therapy group is a more complex matter as it not only involves all the points just mentioned in verbal group analysis but also has other elements, such as tactile art materials, the smell of art materials, and the visual stimulus giving increased access to childhood and school memories. These associations originated in childhood expression of art and later school art experiences. The creative processes are also opened up along artistic lines in parallel with the verbal/non-verbal components. The structural framework housing content and process is a dynamically creative milieu. Winnicott speaks about the imagery of the transitional object, the transitional space and the area of creativity. Foulkes also saw the space within the group as potentially creative. Malcolm Pines wrote about Foulke’s contribution:

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There is a strong socio-biological aspect of Foulkes’ formulations… The group has an inherent pull towards the socially and biologically established norm. Though he wrote that adjustment in a therapeutic group means social adjustment, he was very far from meaning that this meant adaptation to the superficial aspects of communal life. The type of social adjustment that he had in mind was one that would enhance each member’s creative individuality and potentiality and which would reduce neurotic inhibition of spontaneity, sensitivity and capacity for full emotional participations and relationships. (Pines 1983b, p.272)

One can see a relatively clear line between what is defined descriptively as content and process. The content is the more structured elements and the process is confined to that which forms links in the structure and dynamically moves elements in space and time. As I said earlier, these are simple descriptions and do not explain fully the interchangeable nature of content and process. There is a symbolic relationship in play here. Foulkes’ concepts of the gestalt of ‘figure-ground’ are highly relevant. One minute we see content, at another we see process, but the two are always in our overall vision. Such differentiations, as Foulkes has suggested, are false dichotomies and are used only for descriptive terms. Pines says: The group analytic situation can be analyzed into three component parts:

1. Structure. These are the patterns of relationships that are relatively stable and continuous and which arise out of the continuing interaction of the members of the group. These patterns of relationships take shape as habitual roles taken up by the individuals, as configurations between several members of the group. Alliances, subgroups, divisions, are examples of these. 2. Process. This is the dynamic component of the situation and is manifested as the interaction of the elements of the situation in their reciprocal relationships and communications, verbal and non-verbal. 3. Content. Content is transmitted through the channels described above. It is through the analysis of the content, transmitted through structure and process, that psychopathology is revealed. The content that will emerge is determined by the structure and process already described. It is for this reason that the group

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analyst pays fundamentally more attention to structure and process than content. (Pines 1983b, p.273) I feel that immersion, almost to the point of forgetting oneself in a given situation of the group, has a strong relevance. To be immersed in the group carries with it a suspension of time and space, a belief in the analogous amniotic fluid that inhabits and surrounds content and process. Given acceptance, the process will nourish, while surrendering individuals to the existential nature of experience in the group, and the need to delineate content and process will lose its significance. Therefore, although group analytic art therapy provides much that can be ascribed to practical or concrete structure in the availability of art materials and how these are processed sequentially, there are many more subtle elements that can be studied. In writing the previous points, I wanted to convey something more simply. I thought: what do I love about group analytic art therapy and verbal group analysis? The love for one’s work is extremely important. Can it be love when a group struggles through pain and suffering or negative transference towards me? I think so, as I believe that content, process and structure elements are part of a process leading people to change and a greater love of their own life. On another level, I experience being a group analyst and psychotherapist as one of the most lonely and isolating experiences, and at such times, I haven’t a clue as to what is content and which is process – it’s just awful. To love as a therapist means a readiness to immerse oneself in the overall experience of the therapeutic endeavour. In verbal group analysis, one could surmise that a baseline of content is the spoken word, with a process being akin to group associations. Also, the process of risk-taking leads to disclosure and the resolution of conflict with the healing of illness. The same applies to group analytic art therapy, but the contents are also the acts of making concrete pictorial imagery along with the individual creative and artistic development.

Specifics of content and process The following lists various situations in which there are specific features of content and process. It is beyond the scope of this book to expand on these. Although each specific point has generalized features of content and process that are inherent, each also has its uniqueness. With this in mind, we see

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many variations in content and process, some of which I have illustrated throughout this book within the following: ·

the first session of a new group

·

the developmental stages of the group

·

the immature and the mature group

·

the new person entering an existing group

·

the group that has become stagnant or regressive

·

the group dependent on particular mechanisms, e.g., individual counselling within the session

·

key events in the group’s life, e.g., member leaving, member becoming pregnant, therapist getting married

·

administrative aspects, e.g., early dropouts, difficulties in replacing vacancies, absence, illness, destructive processes

·

‘group as a whole’ symbolism, e.g., great or devouring mother, depressed or neurotic group, anorexic or bulimic group.

To this general list we can add some further specifics to the group analytic art group: ·

the apparent task-setting through concrete imagery

·

the potentially greater use of silence while the group makes imagery

·

the apparent split between individual expression and group (verbal) sharing

·

the dynamics of movement between concrete imagery and verbal language.

My intention in presenting such a summary is to raise the reader’s awareness of the complexities of understanding content and process as a dynamic, living, interchangeable set of factors within specific frames or contexts. All of these frames can cross-refer, for instance, a new member with anorexia comes into an existing group that is symbolically enacting a bulimic ‘group as a whole’ identity, i.e., anything of goodness is gorged and then spat out. Bearing these points in mind, the various headings draw our attention to the

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possibilities of what may happen at a particular time or in a particular group session. Wherever we place our attention on process, content or structure, we shall also need to consider the interplay between all parts of the whole tripartite system.

Clinical illustration I shall address the primary elements of content and process within the first session of a new art group. As this was the first session of a new group, I gave a verbal introduction, during which I spoke about expectations and how on future occasions we (the therapists) expected the clients to come into the room and paint, draw or sculpt whatever they wanted. This would be followed by a verbal section. The overall time allocation would be approximately 50 per cent for each section. The verbal section was an arena to speak of the images and whatever else the clients wanted to discuss. The therapists would never give specific themes or topics. From this point, the clients went to the tables and began to make their images. Although I told them they were free to speak if they wanted to, they were generally quiet throughout. This seemed linked to the initial anxiety. There was an initial pairing at the beginning of the image-making: ·

Dawn and Melissa shared one piece of paper cut in two; both drew.

·

Tom and Belinda created exuberant paintings.

·

Mary was on her own, drawing and painting.

Figure 10.1 shows the images produced: Belinda:

Mary: Dawn: Melissa: Tom:

Three pictures: two abstract pictures created by paint being squeezed from tubes directly on to the page, with the letter ‘B’ as the baseline (the first initial of her name); the third painting was a doodle made from this imagery. A picture of gates and musical symbols in a semicircle. A drawing of a park scene with an empty bench. A still-life drawing of houseplants in the art room. A painting of poppies (flowers) in a field.

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Belinda

Mary

Dawn

Melissa

Tom

Figure 10.1 Art group illustration.

When we moved to the verbal circle, there was further hesitancy as to whether they should display their work, with added silence. There was a silent expectation that I should take the lead, as they were looking towards me. I suggested they share their work with one another. The focus then moved to an exploration of the imagery – the pairing continued from here with Tom and Belinda. Belinda felt liberated in free

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expression with the paint, reminiscent of school and envy of her own children who would normally do this. There were associations and a generalized feeling of being threatened with the prospect of freedom to create anything, which moved to a more specific focus on each individual’s imagery. Dawn’s park scene was an attempt to paint a relaxed scene in order to counteract her initial anxiety. Melissa painted a houseplant as she could not express the more nebulous feelings she experienced. They saw little commonality at this point, but I suggested that there was anxiety about beginning a new group and dealing with expectation on various levels while re-experiencing feelings akin to their first days at school (note Belinda’s work). I made further connections to personal adaptation, each having their own space to be playful and creative. However, there was an initial anxiety, which is generally present in all new groups. I also commented on the art-making process of moving from their initial fears and anxieties, to self-absorption to being relaxed during the making of their pictures (three stages). They then began to speak about what brought them into therapy. As well as speaking about their symptoms they highlighted a positive reaction to me during the period of assessment, before joining the group. They seemed to be hopeful and trusting while dealing with their personal fears of the unknown. I suggested that in joining the group, there was a search for belonging(ness). This was built on hope for change and the fear of failure as two components. However, what may have been difficult to see in the new group was the element of success in going through assessment and starting the group. The focus moved back to the concrete imagery, with questions about and associations with the pictures, e.g. ‘What’s the purpose of the pictures?’ (to me) and ‘It’s like two groups in one!’ I stated that it took time for the apparent split to be reconciled and for them to see that painting and drawing and talking were all part of one group method. In the closing minutes of the session they begin to consider how they would use the session in the following weeks in respect of the image-making part. This ranged from having a preconceived idea on what to paint – but it would be easier to paint something that was emotionally difficult rather than speaking about it – but Melissa declined this in favour of waiting to see what happened each week. There were, potentially, two reasons for this: the desire to deal with future anxieties of a similar nature experienced today and a positive (unconscious) wish to keep the link between sessions.

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In order to clarify the interchanging dynamics of content and process, I present a sequential breakdown of the session: 1. Start of session (a) initial introduction: setting the scene (b) pre-image-making dynamic of pairing 2. Image making: primarily silent with three distinct stages: (a) anxiety, fear, trepidation (b) self absorption and engrossment (c) relaxed state and playfulness. Midway: everyone moves to another part of the room in order to speak. Verbal session 3. There is an initial hesitancy in sharing and showing the finished pictures, which are dominated by two aspects: (a) silence (b) the wish for me to be the leader through the group’s expectant gaze to me. 4. The first focus on the artwork is parallelled by pairing. There are two further components: (a) anxiety, without a given theme from the therapists (b) a sense of liberation without it. 5. There is generalized expansion of personal associations with the imagery, which moves to: 6. More specific dialogue regarding each other’s imagery. 7. I introduce an interpretation: technically, this is a bridging interpretation, with the aim of making connections and emphasizing commonalties where they thought there were none. 8. My interpretive comments are stepped up to process commentary on the following stages: (a) initial fears and anxieties (b) self-absorption (c) relaxation (d) verbal communication.

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This interpretation leads inadvertently to a deepening of the process to the following: 9. Exposure of the psychological difficulties that brought the clients into therapy. This is expressed in three particular ways: (a) sharing of symptoms (b) retrospective links to their psychological assessment with me and the instilling of hope (c) dealing with deep-seated fears, which resonated in this, their first, session. 10. The closing interpretations: a holding variant. The primary aim of this is to bring together the overall experience of the session, which results in: (a) further meaningful exploration of the artwork (b) scepticism on the value of the art part of the group (c) a dual dynamic of short-circuiting future anxieties and creating a sense of continuity. I hope that this breakdown illustrates the theoretical points raised. One could evaluate any group analytic group session from start to finish in such a way.

The basic principles ‘We come into this world alone and leave it alone.’ ‘Life’s a struggle and then you die.’ These are dark, stark and pessimistic views of life, the first being individualistic, the second emphasizing a certain view that life is not worth living, almost stating an individualistic stance: ‘Don’t get involved, you’ll only get hurt!’ ‘Don’t smell the flowers because they’ll die.’ The basis of this preamble is to agree that we come into the world alone, but to point out that we are born into a group; in fact, by being born, we make a group. Even if both parents died at the moment of birth, there is a reality that for a brief period a group existed and was in part created by the newly born. There are stories of children being born or abandoned in the wild who have been saved by primitive people or animals. It is possible that there is some innate instinct that comes into play at these times, of recognizing the threat and distress of potential aloneness (see Armen 1974). The baby left and crying in the wilderness is discovered by wild animals who instinctively act to include the infant in their group (although, of course, he may be devoured).

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The hermit who, for various reasons, withdraws to the hills may feel that he or she is alone. Is this wish to be alone an escape from various family or societal groups or a search for inner peace? We know that hermits exist in our society. Likewise, the nun who retreats to the convent may have a primary aim of getting closer to or being with her God. However, being in a convent entails being part of a group. The nun may have more chance of having an individual relationship with her God than when in society at large, but she is still within the matrix of her sisterhood. However, many holy orders of nuns form a central part of their societal community, so this throws a different slant on it. I have postulated the possibility of an instinct that forms and holds groups together, with a tendency to rescue the threatened isolate. This, I believe, is different from Trotter’s Herd instinct because it is not about a herd being led blindly by one leader. Such an instinct may have been at play in recent wars in which a group ideal or directive appeared to supersede the individual at all costs. There are similarities with the two world wars. The Easter Uprising in Dublin in 1916 emerged at the time of the First World War. However, what seemed to be created was that a small group of Irish republicans orchestrated the siege, lighting up a moment in time (seven days) that was to lead to the free state of Eire. However, the scar of the border between north and south remains, although nowadays there are no bricks and mortar or army checkpoints in the way. One could be led to believe it does not exist, as nothing is visible. Returning to my opening statements in respect of entering and leaving the world alone, this misses out on what happens while we are alive. During life, we move through many group settings, which we may feel a part of, removed from, separated from or isolated from, to name a few. The expression ‘feeling alone in a crowd’ describes a common experience. Likewise, there are differences between feeling alone, lonely and on one’s own. In order to go through these complex changes of mind and setting, I believe one has to experience the demands and challenges within a group.

The individual in the group as a whole As I stated earlier I am moving towards drawing together these two concepts into one union. It may appear repetitive at first glance, but I hope that something new will evolve. Within the psychoanalytic dyad there may be a myth that it is only about the individual patient’s pathology, state of mind or intrapsychic transference issues. This cannot be true, as the patient brings his

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experiences with their life group outside, just as the analyst has his own groups outside as well as other clients. The more a person can become part of a group, the more individual they become. Likewise, the more an individual can be himself, the more he will be able to create and shape the group he belongs to. As stated previously, the phrase ‘the ‘individual in the group’ places the individual in the foreground, with the group in the background. However, this is not a totally accurate picture, because the individual, although being in the foreground, is dominant against the background. It is not uncommon for patients to explain the group as something else that they are not a part of if things are difficult, whereas they may see themselves as part of it if there is a sense of harmony and contentment. In therapeutic and theoretical terms, we can conceptualize the phrase ‘the individual in the group as a whole’ when an individual is bringing forth parts of their past and present experiences, which help us to understand that individual. The individual is speaking within the group about his individual and other group and family experiences, which then allows this to be part of the ‘group as a whole’. This may well resonate with other individuals, who may then step out of the background and into the foreground of the group dialogue and are then themselves seen as individuals in the group. This collective pooling of the members’ experiences goes towards the ‘group as a whole’ formation. There may then be a central theme or reference point to give form to the identity of the ‘group as a whole’. One common fear is that the individuals will be consumed by the group and lose their individuality. As well as the fear of being consumed being a normal configuration, loss of individuality becomes particularly relevant to those who enter the group with specific difficulties, e.g. individuals with narcissistic or borderline personalities, people who have experienced extreme abuse, people with severe eating disorders or disorders of the self and people with highly controlled or introverted personality structures, to name but a few. Each of these individuals will have his own particular individual positions in the group which may be hard to transfer to the ‘group as a whole’ membership. The battle to be part of a group identity involves many hurdles. There is both a yearning for and fear of belonging between the ‘individual in the group’ and the ‘group as a whole’ in such scenarios. Also, if one considers the silent member in the group, this can be a graphic illustration of an apparent split between the ‘individual in the group’ and the ‘group as a whole’. The reasons for silence of an individual are extensive. I will address the ‘group as a whole’ silence

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later. Put simply, the individual who maintains a chronic silence may be stressing an individual stance of either fear or resistance. Can this be equated with the hermit living in the group? The hermit takes an individual silent stance, which can be seen as either counter-‘group as a whole’ or fear of losing individual identity. Clearly, such individuals have the opportunity to express their individuality in the group. A ‘group as a whole’ perspective may tolerate such a silent individual and at times raise him to a venerable position. Other groups may not tolerate such individuals, leading to expulsion of the individual. I believe that many individuals gain a benefit from being left in their individual silence, but I think that damage is done to the ‘group as a whole’ by accepting long-term (six months or longer) silent individuals as part of the ‘group as a whole’. In group analytic art therapy, these factors are clearly present in the form of people refusing to make images, producing blank pages or refusing to let others see their work. However, there are a number of other, unique components. In its simplest form, the production of each individual’s concrete imagery gives a solid individual contribution to the group analytic art group. With the art group, the fact that an individual creates his own unique pictorial imagery expands the notion of the ‘individual in the group’ expression. With words, it may appear that strong ‘individual in the group’ statements are consumed in the group quagmire and then lost to the ‘group as a whole’ configuration. Each pictorial image has its own configurations, which helps us to see more clearly a defined image of individuals within the group. With the primarily verbal group, individual statements melt into the ‘group as a whole’. With the group analytic art therapy group, the ‘individual in the group’ pictorial imagery maintains its individual separateness, while contributing to the ‘group as a whole’ structure.

The group as a whole inclusive of the individual When Foulkes looks at the group and individual in new perspectives, he writes: We have become used to thinking of intra-psychic processes, ipsofacto as inside the same individual person, inside the same skull as it were. If we make such an assumption we beg one of the most important questions which arises. The fact that these mental processes are taking place physically in each individual brain is undoubted. If we hear an orchestra playing a piece of music, all the individual noises are produced each on

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one particular individual instrument, yet what we hear is the orchestra playing music, the conductor’s interpretation, etc. We do not even in terms of pure sound hear a simple summary of all the individual waves, which reach our ears, but these are modified significantly, being part and parcel of a total sound. In the same way mental processes going on in a group under observation reach us in the first place as a concerted whole. Those familiar with Gestalt psychology will find no difficulty in understanding that the whole is more elementary then the parts. With this insight we have arrived at one of the basic concepts in group psychotherapy without which all other observations are misinterpreted or insufficiently described, namely that what we experience in the first place is the ‘group as a whole’. (Foulkes and Anthony 1984, pp.25–6)

Bearing in mind Foulkes’ comments, it is easy to see how the score of group analysis can be cross-fertilized with group analytic art therapy. More so, the uniqueness of the individual instrumentation as portrayed in the visual imagery can be seen. Foulkes appeals to the creative side of the group psychotherapist with a musical analogy, addressing the abstractions within language and other non-verbal communication. Visual artists, unlike musicians, rarely come together to create collective images, apart from when it is to express a collective message. These messages are often of a social or political nature, and then such power can often be channelled through large-group systems. The ‘group as whole’ is a silent but ever-present force holding the individual and, thus, nurturing his individual development. When a group paints or draws an image together, one can see a collective or ‘group as a whole’ diversion. When images are created on an individual basis within the group one can locate the many points of commonality and divergence that help us to conceptualize the phenomenon of ‘group as a whole’. This is evidenced in a number of ways, for example, similar images being created, the resonance of colours, numerical expressions such as the number of symbols being created equating with the number of group members, and particular symbolic images being created by more than one person, such as storm imagery being reflective of unresolved conflict in the group. There are many more configurations that help us to understand the group as a whole within group analytic art therapy – these have been just a few examples. The clear visual differences that are observed between a group analytic group sitting down with language as their currency, as compared with the group using art, is striking. In the art group, once the concrete imagery is completed and the group

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begins dialogue, unification or diversity of the group as a whole can at times be immediate . With the primarily verbal group, it can be more difficult, and less immediate, to reach group-as-a-whole conclusions. The art group may appear more seamless through the presentation of imagery denoting such factors. The ‘group as a whole’ is not removed from the ‘individual in the group’. In fact, the two positions cannot be understood in isolation. However, we tend to formulate our understandings of the ‘group as a whole’ as encapsulating greater dynamics beyond the individual, but inclusive of him. Groups may both exhibit a satisfactory level of achievement as a whole and re-enact individual and group experiences from the past that were either stuck or similar to previous experiences. Hence, on the positive side, the ‘group as a whole’ may create nurturing and resolving dynamics. Here, the ‘group as a whole’ becomes a creative life-giving whole, promoting greater individual liberation. On the negative, destructive side, the ‘group as a whole’ is a repetition of previous experiences that were ego-dystonic. The ‘group as a whole’ in these situations may reflect the individual’s personal psychology of stagnation and petrifaction. Just as in the primarily verbal group, the members of the group analytic art group may create imagery in order to support such wholesale defences. This could be an individual’s refusal to paint or draw or the production of minimalist, destructive imagery. On further exploration, it may be seen that this is reflective of the whole group’s resistance and anger with the conductor. If this is not resolved this can lead to stagnation and petrifaction, as stated earlier. Similarly, on the positive side, the various individual expressions (in both concrete and verbal imagery) can portray the health drives and achievements symbolically. Previously portrayed dark and sombre scenes are replaced with bright and hopeful images. Rooms with no furniture and doors are replaced by mansions, castles or comfortable houses with picket fences, families and dogs. The group that was previously displayed as judge and jury is replaced by the individual being let out of prison. The group that was previously on a desert island with the individual drowning at sea is replaced by a Spanish galleon laden with treasure, entering the home straits and with all on board. The individual being bullied and cowering in the schoolyard and the bully are equated with the dangerous group. This is replaced by everybody playing and the bully being expelled by the headteacher. The image of the wrist-cutter with blood flowing is replaced by a healthy person, although with scarred arms, in a group party.

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Although each of these individual pictures may be expressed singularly or multiply, this will allow us to experience, evaluate and analyse what each of these say for the ‘group as a whole’. Therefore, ‘group as a whole’ interpretation can help us greatly, as it moves away from what may be perceived as retaliatory and punitive individual interpretations. Likewise, the same messages emerge on the positive side in which the ‘group as a whole’ interpretation acknowledges both the individual and the collective changes in position. With the clear pictorial evidence of positive change, the ‘group as a whole’ expresses achievement and hope for further change. In keeping with this line of enquiry, I trust that the various perspectives described help us to consolidate the perspective of the individual in the ‘group as a whole’ although I have focused on each side of the continuum in my attempts at integration.

Commentary Unlike in Chapters 3 and 4, in this chapter I have attempted to bring together the two areas of ‘individual’ and ‘whole’ group perspectives as a more unified whole to emphasize a closer band between the two positions. To illustrate this, one can picture an elastic band, a loose circle of rubber at rest. If one exerts equal pressure or tension by inserting a ball, here is the ‘group as a whole’. The rubber band surrounds the ball while incorporating the properties of the ball. Take away the ball and use two fingers to pull apart the band while it is still circular; it now has two polar points of tension, which can be translated as two individuals taking up opposing positions, or opposing dynamics of the whole group. Then, if one puts three or more fingers inside the band and exerts pressure, one can see the variables of the individual and whole-group equivalents. If two hands are used, or if the exercise is performed with others this adds further to such complexities. However, we must not lose sight that it is still an elastic band that is circular and has its own molecular structure. Children play a similar game with a circular piece of string which is woven and interwoven between the hands of two children in order to reclaim the circle. I hope that this new perspective helps us to see the individual and whole-group thinking as being closer together. Previously, theoretical exploration in Chapters 3 and 4 created a distance between them in order to see particular differences and similarities. This new way of describing things is more in keeping with cross-fertilization. Both individual and whole-group thinking grow from the same soil. Both may lead to greater growth and development or may become blighted, depending on how they are conceptualized and handled. Both can also be

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conceptualized as opening one to the other. In respect of the points of parity and differences between primarily verbal and art groups, I trust that the points I raised show a pushing together of concrete images and words and, thus, a potentially rich and fertile ground, rather than a pulling apart (earlier separatist theories), for the sake of description. To illustrate this further I will describe a clinical art group session. Figure 10.2 shows the images produced: Beatrice: Miranda: Tom: Clive: Anna:

Picture of her sister and her trying to rescue the cat from a tree last night. Picture of Christmas tree with presents. An abstract doodle. Picture of a number of people sitting at a table and chairs (Christmas celebrations). No concrete image.

During the activity part of the session, there was a little starting dialogue before everyone moved into silent image-making, which lasted for approximately 30 minutes. During this time, everyone was engrossed in their own work and did not have the same urgency as in previous weeks to get away from the tables and back to the verbal circle. I told the clients at the start of the talking part of the session that I might be late the following week as I was lecturing in Coventry. There was a lot of humour around this point: it was linked to me possibly not getting back from Coventry because of the difficult road systems that I wouldn’t know, and that I would need some therapy myself when I got here. There is an expression in the UK about ‘being sent to Coventry’ meaning that if you’re ostracized, there is little chance of you getting back. The clients quickly got on to speaking about their pictures and at the same time speaking about what happened in the previous week. Miranda spoke about her plans for Christmas. The ‘group as a whole’ moved into associations and resonances on Christmas. Clive spoke of the various functions that were occurring over the Christmas period, which was shown in his picture. These events in the Christmas period carried feelings of obligation about going to the events and also Clive’s stand on doing what he wanted at Christmas rather than what was expected of him. He spoke about going to his wife’s work ‘do’, which he was partly looking forward to. Anna’s social life seemed to be good for her at present, and she spoke of numerous parties. Beatrice’s picture was linked to her and her sister

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Beatrice

Miranda

Tom

Clive

Anna


trying to get their cat out of a tree, where it had lodged itself with its claws stuck in the branches. On being questioned about his picture, Tom responded that it was just a pattern: he had hoped that this would help him to start to focus his thinking and that it would lead on to something else but it didn’t. Miranda spoke about the loss of her mother, which reflected other losses that were difficult at Christmas. By this point, the dialogue had revolved around the individuals in the group, or individualistic stances within particular demands, for example the

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whole group was defending against the demands of Christmas. Further there was a fear of losing that special individual position, as evidenced in Miranda’s lost relationship with her mother. By this stage, the concrete imagery was in the background. It may be that my individual counter-transference reactions of irritation drove me to begin addressing the ‘group as a whole’. It was also around this point when I brought in the dynamic of patterns. I spoke of patterns of avoiding feelings of loss being replaced with anger. I suggested that the celebrations that Clive had been speaking about were particular patterns; Tom had referred to his picture as ‘just a pattern’. This ‘group as a whole’ interpretive focus seemed to have a mutative effect. It also appeared to have brought an integrating ingredient into play between the verbal dialogue and the artwork. The clients were able to tune into this fairly appropriately, and from this point they ventilated quite a lot of material on specific patterns from the past. I went on later to look at such patterns as either being meaningless repetition or having particular meanings. I suggested to Tom that he didn’t necessarily need to dissect his painting, but by saying that it was ‘just a pattern’ he stopped any potential meaning from developing. Primarily Clive, Tom and Beatrice took up this theme more solidly. Tom had recalled my having spoken in the past about the need for people to take risks with sharing parts of themselves in the group, and this was certainly an issue for him. Clive had expanded further on this by pointing to how the risks he’d taken in trusting people had not been fruitful, which made it hard for him to take risks now. A lot of this was linked into what the clients felt they would get out of taking risks or letting good things go in the process. Eventually I came back to this by suggesting that if they looked at what they’d lose this might give them a different perspective. Here I used the parallel with the cat being stuck in the tree: people had a certain belief in something, and once they had it they stuck their claws into the tree and wouldn’t move. I said to Clive that things would not change unless he took risks, but that he had to look at what he would lose if things did succeed. Earlier, the women were looking at their capacities to be good mothers and how children acted at certain ages, in particular at three years of age. Tom spoke of three-year-olds being naughty and bad, and in a way this was good. However, for Miranda this example was extremely taxing, because she, and the others, were faced with the dynamics and difficulties of being seen to be a good mother. Linked into this was a wish to please one’s parents, and within this I suggested that this was a double message: if one struggled to be

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a good mother, one also had to lose the idea of being naughty or bad children themselves who were continually trying to please their own parents. Both points were linked together intricately. In conclusion, I feel that this session illustrates the dynamic movement between the ‘individual in the group’ and the ‘group as a whole’. The pictorial imagery also highlights these complex struggles, from the image of the Christmas group celebrations to the wish for individual pursuits; the ‘group as a whole’ patterns accompanied by lifelong patterns. Cross-fertilization in this context brings together the visual and the concrete with the verbal. It also sews together the individual and the group in a more unified form as compared with previous, separate descriptions. My term the ‘individual in the group as a whole’ creates a dual.

Further dualities The term ‘dual’ is synonymous with the number two. Individual therapy, be it predominantly verbal or art therapy, is a dual arrangement. In individual therapy, dualism is presented in a number of basic ways, such as the therapist and patient, the conscious and unconscious, transference and counter-transference, projection and introjection, interpretation and response. In any group analytic setting, the same principles are in evidence, but the dualities become more complex and, potentially, fragmentary on the negative side and mutative and integrative on the positive side. Previous chapters have, I hope, clarified these issues. Let me conjure up a mental picture. Imagine the images created through a prism. When I was a child, I had a kaleidoscope. One looked through one end of a tube and turned a cylinder at the other end. Coloured plastic or glass crystals within the tube made different images with each turn. Within the circle, there were overall patterns, while dual patterns crossed the surface of vision. As a whole, the interplay between the overall image and the dual created a dynamic field of vision. Similarly, if one looks through a microscope, one can see similar configurations with cellular life: one particle takes up one position while another takes up another position, microorganisms coming together or separating. One of the dual positions which I spoke of earlier was confusion and fusion. I want to return to this in a little more detail. My first study was on the dualities of confusion and fusion as seen in predominantly verbal group analysis. The paper I wrote then was my final theoretical thesis in submission for my membership of the Institute of Group Analysis. Although I alluded

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slightly to group analytic art therapy, I was primarily studying verbal group analysis. Here, I will attempt to expand on these dynamics within group analytic art therapy. Fusion can be both a desirable and an undesirable state. There are varying degrees of fusion in different aspects of psychotherapy, for instance psychic integration, interpretation and insight and becoming part of a group. A single element cannot be in a fused state: it needs another element with which to fuse. An electrical fuse acts as a bridge between an electrical current and an appliance. Possibly, Foulkes’ views on the individual as a nodal point within a psychic network could be enhanced if one considers that which is between – a synapsis. The concept of a synapsis could be described as a psychic fuse, with a psychic driving force towards fusion. The constant drive towards both inner and outer states of fusion is both a circular and an ever-evolving process of change, both for the individual and for the group. However, the undesirable fusion and fused states can be problematic. Another definition of fusion is that a fixed or rigid state has occurred. Here, the creative drive for fusion has been short-circuited or stopped. This can be seen in areas such as fixed symptomatology, interminable therapy, lack of insight, destructive patterns, chronic obsessionalism and symbiotic states. Regarding confusion, this at first defines a different emotional psychological state. Confusion is experienced and explained as a complex process in which many thoughts and emotions are in flux, e.g. ambivalence, anger, puzzlement, not knowing how to think and act, making a decision and immediately changing it, a preoccupation with oneself while struggling with the confusion. However, if we break the word ‘confusion’ into two, we can see a different picture and discover that certain states of confusion are, indeed, healthy and serve a purpose. One definition of the word ‘con’ is a confidence trick created by a con artist. Here, a state of confusion has been created, a web of illusion with destructive intent. Another definition is of a steering mechanism on a ship. So, if we apply ‘con’ to ‘fusion’, we now see it as a steering mechanism within the dynamics of fusion. Indeed, when I wrote my original, unpublished paper, the title, ‘Confusion and Fusion in Group Analysis’ (1987) came to me when I acknowledged that I was confused in my attempts to find a topic to write about. In primarily verbal models of psychotherapy, there are countless times when confusion is experienced by patients and therapists. At such times, there is both a silent and a verbal struggle to get through to a less conflictual state, a bit like looking for a needle in a haystack. Often, this is experienced

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negatively and patients and therapists rush to get out of the confusion. In the art therapy setting, whether individual or group, there may be added factors, such as the struggle to make the first mark on the paper, the creation of an unboundedness of paint on paper, or the isolated figure cowering in a corner while a storm is raging on the other side of the paper. Therefore, if we see the dualities of confusion and fusion, we acknowledge an intricate link in that both states coexist and one leads to the other. In the group analytic art group, dualistic conflicts emerge as with any predominantly verbal group. In addition, we see particular areas coming more into focus. The fact that art expression is to the fore will illuminate such dynamics as envy and rivalry in the art-making, between those who can paint and draw and those who can’t. Here, the aesthetic productions may oppose the more naive or simple manifestation and we could see the production of a pleasing aesthetic expression as fighting against a simple naive image. On the other hand, there is a searching attraction between the naive and the sophisticated aesthetic expression. There are many other expressions of this theoretical field, such as the withdrawn image in contrast with the exhibitionist imagery, the timid image in contrast to the bold and risky image, the shocking and frightening image in contrast to the image aimed at pleasing, and the full and noisy image in contrast to the blank page. All of these dual sets of imagery can be conceptualized as juxtapositions of magnetic forces, held powerfully while expressing reactive ingredients, which attempt to move the forces apart. Juxtaposition may be seen as contrasting positions, but it may also be seen as two points in the crossfertilization process. Let me now present a further clinical illustration. This session occurred approximately two months before the end of the group’s life. Although the main theoretical expansion is on polar balances, I shall also touch upon the aspects of opposition, encounter and elements of fusional derivatives. Figure 10.3 shows the images produced: Beatrice: 13 question marks. Terry: A doodle drawing. Miranda: No concrete image. Clive: A group of people with Clive on the outside. Sarah: Circle drawing with an inner pattern.

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Beatrice

Terry

Miranda

Clive

Sarah


During the concrete image-making part of the session, little was said between the group members. This lasted for approximately 25 minutes. When we convened in the circle to talk, there was an immediate desire to speak about the pictures. Beatrice’s question marks were looked at first, and these were connected to the ongoing struggles in the group. Beatrice spoke about questions not being answered. Clive questioned difficulties in dealing with change but noted how he had much more difficulty with changing situ-

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ations when he first began in the group, giving a degree of credit to the group for this. The group was quite humorous at this stage. Clive went on to speak about his picture signifying him feeling out of a crowd (note my earlier points on alienation). He had started a new job and had had preconceived ideas that he would not be accepted, but he was accepted. He went on to speak about his wife going through a difficult time. This development had strongly affected his view of the group as a removed and safe place. This progressed, with the whole group looking at the ideals of perfection and the wish for miracles. Sarah said ‘A miracle could happen in six weeks’ (the period of time before the group was due to finish). Sarah proceeded to speak about her own circular picture as representative of the various parts of herself. The dominant parts were the light-brown sections. Within this segmented circle, she felt she was like two people, one of whom was putting on a front, while the segmentation was kept secret. The others challenged this by saying that she tried this here with less success. When they got to this point, it seemed to allow them to confront parts of themselves and of the group that they had difficulty in speaking about, in particular sexuality. Although Terry was unable to expand on the significance of her picture, she was able to associate with and contribute to the sexuality struggle. Clive had maintained the view that his spouse would never leave him. They spoke in some detail about their struggle with sexually physical interactions (encounter and alienation). One outcome was that if men were given affectionate leads, then they would change this into sexual desire and thus kill off affection. The men did not respond. Thus, a polarized view of man and woman was created, with all its oppositional ingredients. In the closing part of the session, I became more interpretively active. I began by addressing the importance of the circle as a perfect roundness. I expanded this by speaking about the struggle in the desire for and fear of intimacy. This was illustrated in the circular motifs in the imagery. It was also present in the dialogue about sexuality and intimacy, in that two people as separate circles needed to come together (a process of merging and fusion but with a fear of annihilation). In forming a new circle, there was the fear of losing one’s identity during the merger. Another hurdle was that people had formed inner circles, which may have become fixed and might make future risk-taking difficult when forming new circles, e.g., Sarah’s firm hold on her memory of her mother, inhibiting a grief process. This then inhibited new and mutative integration with others

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in her present life. For Clive, the preconceived idea of being alienated by his new workgroup was altered by a process of either the group opening up to let him in or him breaking the circle (openings). By this point, I had recognized that Beatrice was having difficulty in coming in verbally. The idea that a question mark is like a circle that is three-quarters complete before changing course moved me to include Beatrice here. One assumes that a question will promote an answer, which is often equated with a solution, something that is whole in response to a question, i.e. the removal of conflict. I had considered interpreting the ‘group as a whole’s’ search for wholeness in contrast to superficial solutions, but I felt this would have complicated things too much. From this point, the group became more open and less guarded in talking about intimate issues, the lack of affection in their lives and how such conflicts are expressed symptomatically. However, not all were on board here. In keeping with the title of Part Two of this book, I believe that exploration of the cross-fertilization between art and primarily verbal group analytic groups is shown in the range of topics discussed. As Tessa Dalley wrote: ‘One has to go back before one can go forward’ (Dalley 2000, pp.84–98). I trust that my revisiting the individual and the whole areas is seen not as repetitive but as something new. Revisiting confusion and fusion is complementary to this. For me, this is an interesting flow of associations. When reflecting back on the points I raised on content, process and structure, one can see various dynamic flows through these, with dual exposés running throughout.

Chapter 11

The matrix, the pattern and the fullness of emptiness

Introduction This chapter is more ambitious than the others in this book and as such may be open to question. I shall consider the interrelationship between the matrix described by Foulkes and the pattern as postulated by Eduardo Cortesão. I will complete the trilogy by expanding upon my own concepts of the fullness of emptiness. Cortesão was the most well-known Portuguese group analyst before his death. Before reading Cortesão’s theories on the Pattern, I became interested in the link between Foulkes and Cortesão after hearing a lecture presented by a colleague, Dr Carvalho, who described the structure and stages of Cortesão’s pattern. I was struck by the paternal connotations, which seemed both to embrace and mate with Foulkes’ ideas of the matrix – or mother. It was as if Cortesão was entering into the world of Foulkes. For the moment, I shall speak of where my ideas on fullness and emptiness originated. These came to me in my work with people with anorexia, in that the drive to express and maintain a sense of emptiness is, paradoxically, full of many things. More on this later.

General perspectives Generally, the idea of the matrix suggests both mother and womb, as stated in Chapter 3. The pattern, on the other hand, is connected to both the paternal role and the interactions of the conductor. This also includes the development of patterns of being and thinking within the group’s life. Therefore, it would seem to make sense that in the life of the group, there needs to be a healthy and continuous intercourse between the pattern and the matrix, between the conductor and the group. 201

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In primarily verbal group analytic groups, these processes occur on many levels. There are added dimensions in the group analytic art group. With each individual’s separate concrete image creation, there has to be an impregnation from the person on to the blank page. The blank page is the seductive matrix culture or the potential womb in order for the pattern to be introduced. This process seems akin to the father and mother within oneself coming into being through the image-making. The mark-making forms and finds patterns in the conventional sense. However, sometimes formless and messy images may be more like orgasms or masturbation. The former feels like a psychic release, whereas the latter may be a preoccupation with the self, expressing difficulties in finding union between the internal mother and father imagos. Individuals’ pictures can then form sections of the ‘group as a whole’, in a way that gives further body to the overall interchange between pattern and matrix.

The matrix As I highlighted earlier, Foulkes saw the matrix as a network of communication having foundation and dynamic levels. Symbolically, this can then be transposed as the foundation matrix being the womb, which is always there waiting to be impregnated. The blank page is waiting to be touched by pencil or brush in the art group. The dynamic matrix may be seen as the child emerging from the womb. The impregnated womb (foundation matrix) leads to the mother – the whole matrix. Therefore, the matrix can be fertile, impregnated or sterile. The blank sheet in art groups has properties similar to those of the foundation matrix; once touched, it emerges or erupts as a dynamic matrix, with production of imagery. This is irrespective of the group member’s gender. Various expressions illustrate this: ‘A pregnant silence’, ‘calm before the storm’, ‘you could hear a pin drop’, ‘to wait expectantly’, ‘the silence was shattering’. Chambers Dictionary defines a matrix as follows: The place in which anything is developed or formed; that in which anything is embedded, such as ground mass…intercellular substance, cementing material; the bed on which a thing rests, such as the cutis under a nail, the hollow in a slab to receive a monumental brass, a mould, e.g. for casting printing type.

Equate some of these definition elements with the group: the place of development or formation: place of embodiment (foundation matrix/ group

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culture); the intercellular substance: the connecting material; the hollow in a slab: the group as a recipient base holding the balance of intergroup tensions; a mould: while holding the interacting tensions, everyone helps to create the mould.

The pattern Cortesão’s views on the pattern are interesting. I do not understand all of them but that may be to do with translation issues. I was able to find only four papers written in, or translated to, English. I was struck by the similarities with my own thinking and formulations, especially when Cortesão considers the fertility of the interrelatedness of the pattern to the matrix. Cortesão writes: It seems also that matrix in itself would not be sufficient to offer specific quality, shape, character, meaning etc. It is here that pattern comes in with a double function: firstly protecting, guiding, directing; secondly, offering a model, impinging a trait, operating change. In the first case it seems related to the Latin pater with an active, conducting, function. In the second, it is related to patron and patronous, also protecting, but offering a model, a sketch, a pre-figure. (Cortesão 1967, p.35)

Chambers Dictionary defines pattern thus: Pattern, patarn, person or thing to be copied; a model; a design or guide with help of which something is to be made (e.g. a set of dressmaker’s templates); a model of an object to be cast, from which a mould is prepared; a sample; a typical example; a decorative design and colours; a design or figure repeated indefinitely; the distribution of shot on a target; match, parallel etc.

Cortesão describes the pattern: By his analytic attitude, abstaining himself from answering in a situation of ‘customary reality’ and offering instead his collaboration by means of interpretation, the analyst conveys to the group a special pattern of relationship and this in turn, induces regression. He does not get personally involved in the patient’s emotional attitudes and beliefs and tries instead to interpret the different contexts and unconscious roots in which behavior and attitudes were cast.

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This is the pattern (from Sanskrit pa, the seed) which may propagate and sustain in a fertile matrix a specific mode of communication and relationship. This imprint leaves its allegiance to the analyst since the group spontaneously becomes its owner, and thus it becomes an ‘integrated pattern, not an imposed one, ‘contranatura’. (Cortesão 1974, p.21)

Foulkes had felt that the use of the term ‘pattern’ was misleading, seeing the therapist as making an impact on the group matrix. Cortesão insisted on the need for the concept and did not find a better word to translate these ideas because it was not so much the imprint made but the imprint that is conveyed. (Cortesão 1971, p.39). Cortesão saw that the group matrix is specifically activated and set in motion under a certain form (pattern) through the attitude and contribution of the group analyst. In conveying to the group matrix this special imprint mutable levels of experience are allowed to emerge. To speak more extensively about these levels would divert our attention unnecessarily. However, it would appear that Cortesão’s pattern is the main axis upon which rest many of his other structural formulations. Cortesão describes five levels within the process, which appear to be extensions of the pattern theories emerging from the pattern–matrix conjoint and help us to understand therapeutic levels of function. Comparing Cortesão’s pattern with the Chambers Dictionary definition, one can see points of comparison, e.g ‘a design or guide with help, of which something is to be made’. There are, indeed, many common and colloquial points of usage of ‘pattern’ and ‘patterns’ within psychotherapy generally. Meeting one’s patient or group at a particular time and place is an imposed ritualistic pattern. Lateness or silent defensiveness are two points among many overt and covert patterns. Art therapy and group analytic art therapy build their models and theories on pattern formulations of shape, colour, line, aesthetics and form or formlessness. Cortesão brings a rich and sophisticated formulation to pattern. The concept of matrix seems somewhat empty without it. I believe that the following formulations will add a third dimension to a previously two-dimensional study of matrix and pattern.

The fullness of emptiness In the Chambers Dictionary definition of pattern, there was a reference to a ‘model of an object to be cast, from which a mould is prepared’ – thus, the mould is the matrix and the model the pattern. With this in mind, there is a


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paradoxical scenario of ‘full emptiness’. Fullness can be ascribed to the ‘model’ or ‘form’ and emptiness to the mould, matrix and womb. There is a similar paradox in the idea of ‘powerful powerlessness’. This concept arose in my work with resistant and passive presentations by patients (and others). No matter how hard one tried to effect change, one was constantly met with a powerful reaction of helplessness by the patient. With the fullness/ emptiness dilemma, similar properties were involved, as the presentation of the fullness of emptiness was a powerful powerlessness. Let me be more specific: Cortesão described a pattern to accommodate the idea of paternal imprints into the group. Foulkes described the adaptation of the matrix to the group with the maternal (womb) imagery at his disposal. In highlighting the fullness of emptiness I describe an almost malignant, consumptive element that draws life out of the womb. Let me expand on how this is expressed in the anorexic position. The majority of anorexics who present are female. Although anorexia is seen as a struggle with food and body image, it is a deeper-seated struggle of the inner depth of the Self, possibly a struggle with the womb. For many anorexic women, the transactions with food are complex, for example the amount, the type, the rituals and secrecy, the variants between internal and external perceptions of body image. I turn now to the aspect of emptiness as the initial and widely experienced feeling of many, if not the majority, of the anorexic women whom I have met. A group can also express a sense of emptiness within silences, apathy or withdrawn positions. It is more powerful powerlessness that I have noticed with groups in respect of the dynamics of withdrawal and apathy in verbal groups. One sees further dimensions in the group analytic art group, e.g. individual and collective blank sheets, minimalist imagery, images of despair and hopelessness, single images of isolation and/or loss. Howe writes: The facts of life are far from self-evident to the egoic man, if they happen to differ from his familiar expectation of what is ‘good’ for him. For instance, a process of self-diminishing towards that end can never seem so good to egoic man as an activity directed towards filling it with something which he thinks he needs. Egoic man is allergic both to emptiness and to peace. (Howe 1965, p.76)

I discovered a paper by Marissa Dillon Weston that runs parallel to similar ideas of my own. There is much that I could quote from this rich paper. Weston explores the expressions and connections between anorexia, emptiness,

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the matrix and motherhood and how these are evidenced in the group within the context of the institution. ‘In group analytic terms, the overall sense of emptiness I experienced led me to think of an empty matrix, similar to a spring which has dried up or a womb which can bear no life because it is dead itself ’ (Dillon Weston 1999, p.71). Further: Working with anorexics individually or in groups, one of the most powerful feelings I experienced in the counter-transference is one of emptiness, just a bleak emptiness, oppressive, life draining and all encompassing… The emptiness I experienced is sterile, it is not waiting for the winds of creativity to rustle its silence. What I experienced is the emptiness of death where everything is heavy and frozen and no movement is allowed. (Dillon Weston 1999, pp.71–2)

The reader may see how Dillon Weston is writing about the relationship between anorexia, emptiness, fullness, the empty matrix and the womb imagery and creativity. When hearing accounts about emptiness, I feel a painful empathy. I feel drawn to reach inside through the exterior fragility of the body to the heart in the emptiness. That feeling of emptiness was like an inviting chasm giving the impression that the person was expressing a sense of nothingness but eventually that didn’t feel right. It felt that the struggle to keep out food was also an attempt to guard the inner world of emptiness. The food coming in could be too much, no matter how little there was. It would come in and stay there, like a separate thing entering the chasm of emptiness. There was a fear of it moving into a state of metabolism where it would make a link or bridge between internal and external reality. Outcomes of this might be that the body would put on weight, and menstruation would begin. Then, the inner world of emptiness would also be threatened, and those outside would not see the internal pain. Then I saw the links between food, the anorexic struggle and the equation with impregnation. Hence, food would impregnate the stomach as if it were a womb; the emptiness would be inhabited; it would have symbolic equations with pregnancy. Therefore, the need to keep the inner feeling of emptiness would inadvertently maintain a sterile position; a reaction against the dirtiness of sexuality; a prepubescent state; an attack on the growing womb of wom(b)an (motherhood) and, at times, an attack on the patient’s internalized own mother. The causative factors are numerous, ranging between difficulties in mother/daughter relationships, sexual abuse, oedipal struggles, sibling rivalry, and only-child struggles, and


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societal factors such as peer pressure, bullying, isolation, abandonment and media pressures. Once I had delved the depths of this emptiness on a theoretical and practical level, I had moved into the patient’s lower strata, where something else beckoned with reverberating sounds, almost like sonic (alpha) waves. These were unconscious and suppressed or repressed emotions, such as rage, hate, anger, sadness, hurt, deep shame, the wish for revenge and internalized self-loathing, to name but a few. However, this was dangerous territory for all concerned. To reach this level therapeutically takes time and energy. Such full feelings were often seen to be better left dormant, as previously the patient could enact the self-attack and avoid the need to bring such full (generally negative) feelings through the emptiness. This therapeutic process would then transform the previously external patterns surrounding food to elaborating the internal pattern that is attacking the inner mould or matrix or womb, thus creating new patterns and, subsequently, creating a new mould. Psychic and concrete food may then be perceived more healthily and utilized. Let us briefly consider silence within this context. I am not concerned with explaining the use of silence as a therapeutic technique, although a new thought has arisen from the earlier commentary on intuition (see Chapter 9): that to gauge and discover the potential meaning of a given silence is an intuitive act – one feels one’s way through it. Therefore, in the context of emptiness being expressed in the therapeutic session, the therapist will fumble in the dark as the anorexic patient subjectively experiences fluctuations through nothingness, emptiness, ambivalence, self-loathing and anger. Drawing from the literature, there are two comments that I believe are in tune with my views on the intuitive elements of therapeutic silence. Van Sweden writes: It is essential also to consider that the analysand’s silence may be a necessary factor in being able to regress to the pre-verbal level of feelings. During periods of silence it is essential that the analyst be ever present, monitoring his own feeling states for information as to the feeling state of the patient. (Van Sweden 1995, p.143)

Karasu writes: ‘In psychotherapy, however, the adage [silence is golden] does not always hold good: the gold of silence can also tarnish as the clinician overrates its utility and the patient in turn misinterprets its intent’ (Karasu

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1992, p.92). When thinking about silence in groups, Wolf and colleagues state: Silence is not necessarily resistive; on occasion, it represents a period of renewal, integration, mediation, or deep feeling without the need to express, act, or respond immediately to the other. While one member is quietly examining a problem, another may be unavailable in resistance. Still another may be too apprehensive of exploration for the moment, and two others may be involved in an intense interaction and invite analytic enquiry. (Wolf, Kutash and Nattland 1993, pp.100–101).

A happy accident occurred when I came across a short story by Marylyn McLaughlin: I didn’t like fleshiness. I have the spirit of an acolyte, pure and clean. I don’t like sweating and sneezing and blowing your nose and those other horrible things that boys go on about all the time, and this other thing – I was not doing it. Just not. Never. A thing like that would not happen to me – all the whisperings and pains that you couldn’t say what they were, a hidden contamination. I did not want to grow up. I would not become a woman if this awful smearing shameful juiciness, this dreadful spreading uncomfortable stain, was part of it! And it hadn’t happened to me – that’s because I stopped eating when I began to grow. And it stopped. I hovered below the crucial body weight (quote from doctor). (McLaughlin 1999, pp.22–3).

This extract tells us beautifully about the mind of a young woman at the start of her puberty and the connections between the anorexic struggle. Returning to how the trilogy of the matrix, the pattern and fullness/ emptiness are connected, let me clarify something. Foulkes seemed most concerned with the matrix as a thing in itself creating shape, safety, containment, an arena for interaction and communication. Such a containing symbol has deep historical roots, even to be compared with Jung’s collective unconscious (Jung 1959, pp.42–53). Cortesão , on the other hand, brings the pattern symbol on line with a paternal driving force, the father moving the group along in various ways. Fullness, in a similar way to the pattern, gives form; it goes inside the emptiness in a similar way to the pattern going into the matrix. Fullness can be located within or underneath emptiness and vice versa. Pattern is in matrix, and matrix in pattern. There are also similar dynamic struggles in patterns and matrices being seen as full or empty, e.g. the loudness of a voice that returns across a canyon through the echo or the


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expression ‘empty containers make the loudest noise’. Conversely, the emptiness of fullness can be described thus: ‘The art of speaking without saying anything’ or ‘Drink talks’, are well-known phrases in Britain. Earlier, I described the fullness of emptiness as an almost malignant, consumptive pattern. I went on to elucidate such a presence in anorexia. Let me elaborate these dynamics as seen in verbal and group analytic art groups with the aid of a biological equation. When a group gets into difficulty, the expression of such difficulty can take on a form that, like a cancerous growth, has a devouring malignancy. The group’s inner blood supply is damaged and the nervous system’s resonant powers are likewise affected. Therefore, the matrix and the pattern are kept apart, like warring parents. For those acquainted with such dynamics in groups, it will not be difficult to envisage the many ways in which groups portray such difficulties. In brief, for those not acquainted with groups, here are some examples: the group, that has collectively formed a depressed whole (empty) while repressing anger and rage (fullness); the group that shows a manic presentation (fullness) while repressing depression (emptiness); the group that becomes bound narcissistically (full of self-importance) while fearing intimacy and subsequent annihilation (emptiness). Part of the Narcissus myth is that Narcissus has to keep looking at his reflection, otherwise he will die. Love and death are often bound closely, for instance loss of love brings a feeling of death (‘I can’t live without her’). Within an art group, people will portray many images that reflect such struggles, e.g. dark foreboding pictures in contrast to vibrant and/or destructive violent images, either of the self or others. Narcissistic imagery that shows people in a superior position or removed in a self-defacing position from others, or the excessive use of written words, is in contrast to images that portray feelings of nothingness, insignificance and/or abuse. Another variant may be that manic expression comes forward as excessive image-making: the paper is filled completely and paint is spurted on to the paper in contrast to images portraying isolation, being lost, first days at school with Mother walking away from the school gates. However, there may be times when such expressions and dynamics are not pathological statements, for want of a better phrase. Not all such activities are defences; there may be healthy excitement misinterpreted as manic flight, apparent depression may be sadness, apparent loneliness may be an expression of attempts at healthy separation, being left at the school gates brings the start

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of healthy fears and expectation. Therefore, what appear as empty positions are full of potential for movement and change. In the methods required for working with groups, one has to be prepared to enter the various stages of emptiness and fullness, on both an emotional and an intellectual level, recalling my physiological similie that in moving along the fullness/emptiness dynamics, one is becoming deeply involved in the cardiovascular and nervous systems of the group. Esher’s ‘House of Stairs’, a black and white painting, is a good illustration of the points I am conveying here. One minute our focus ascends; the next, it descends. Here, there is a powerful powerlessness, almost as if the painting is controlling the viewer. When we parallel the emptiness/ fullness with the powerful/powerless viewpoint, we see further points of interest. An art group that portrays a sense of emptiness along with the overt symbolism (images of death, figures bereft, people being tortured) can have a powerfully debilitating effect. On the positive side, a group can feel alive, excited and powerful while being empty of intellectual meaning. At times like this, I have said either little or nothing since interpretation would seem either meaningless or even undermining. The group session just ‘is’. There have been times when I have said ‘I haven’t a clue what’s happening’ or ‘There’s nothing wrong with creative chaos’. There may be times when an individual or the whole group resists making images. This shows beautifully an art group with no concrete art. The conductor may experience an emptiness, which if strong enough can be powerfully consuming. However, on further exploration we see that for a group to produce such a strong reaction, there must be a powerful ingredient. We must then step away and move through the emptiness of concrete imagery and into the fullness of silence and language imagery. The group is now creating non-verbal and verbal imagery. The power of the single dot in the middle of the paper also shows the emptiness of the surroundings. In Greek mythology, the image of sisyphus forever rolling a great stone up a hill shows a powerful battle within an apparently futile task. This is not dissimilar to making a single dot in the middle of the paper and keeping one’s attention captured. Such a myth focuses on a punitive aspect and draws our attention to empty futility. It ignores the power in the powerless man who is chained to his destiny. In breaking the chains that bind him, does this also remove his power, thus leaving an empty shell, or is his powerlessness transcended to allow him to see that if he had so much power for so long for a meaningless


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task, then surely it can be converted? Is this not an important part of all therapeutic endeavours? I would suggest, therefore, that all art therapeutic methods should accommodate such elements: Look for the opposite. Take and don’t take the obvious. ‘Become’ with your patient the blood and nervous system of the picture. Let it live and be alive within the image. Be the dot or the space and get involved with the boulders rolling. Returning briefly to anorexia, let us consider this in an art group (there are similarities, and differences, in a verbal group). Individuals will produce concrete imagery denoting their struggle with food, image and body. There may be stick figures, sexless images, portrayals of self as children, figures locked in cages, food (seldom have I noticed drink), images of abusers. Images of isolation often prevail. There is an opening up to others in these pictures, but there is also a counter-position of ‘don’t come in or get too near’. This then brings clearly into relief the powerful/powerless position. Here, the strong power that the anorexic person has feels unassailable, while showing the sense of helplessness and suffering of this individual. If strong and enduring within the group, eventually this feeling of helplessness will cause others to feel they cannot feed the person, and eventually the ‘group as a whole’ re-enacts the anorexic position and ends up feeling impotent. Earlier, I drew a parallel between anorexia and pregnancy. However, the notion that women with anorexia exhibit a child’s persona in the group removes the prospect of symbolic pregnancy. I have often heard grown women with anorexia referred to as ‘girls’. The deeper levels of full feelings underneath the emptiness, and the mobilization from and through the whole matrix, are seriously hampered within the anorexic position. The group’s flow of psychic blood and its nervous system is damaged or blocked. Many years ago, a severely anorexic patient in one of my groups in her first session (art group) spoke so quietly that few of the others could hear her. I interpreted this to her as an ‘anorexic voice’ – almost empty of speech. Eventually, she did very well, but in her last session, after two years, she reverted to speaking quietly and I stated that she was moving back from a fuller healthy position to the anorexic voice. From deep inside, she roared at me, calling me a few choice names in a warm and humorous way: we could certainly hear her then! Returning to McLaughlin’s novel we see a relatively happy ending similar to that of my patient. The young woman blossomed after being given the creative space to grow up. I’ll never forget that summer. I began to put on weight. I didn’t mind. I really didn’t. I felt a softness grow on me. I became my own body and

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allowed myself to flow freely into every corner of myself. When I breathed in, I breathed right to the soles of my feet. And when, one evening, alone by Granny’s angels, just as the sun set, I felt the warm blood of womanhood unfold between my legs, I felt neither contaminated nor ashamed. I felt I flowed like the tides of the sea, splendidly. (McLaughlin 1999, p.32)

Likewise, a whole group can express concrete imagery that is reflective of a developing group anorexic ethos. Within the process, the group struggles with the members, showing how little they have or what they have lost (emptiness) in contrast to their growing problems and illnesses (fullness). Then, the powerful and powerless struggles come into play, and the battle is on. The group may now thrive or become regressed leading to a plateau of starvation. As time proceeds, deeper levels of conflictual emotion emerge, and in this process psychological feeding is possible. The ‘group as a whole’ moves to a sense of fulfilment. However, sometimes a bulimic mechanism is used: the group spits things out, inhibiting further thriving. When the group moves into a more amenable, receptive position, we can accommodate the adult plane and explore the sexual imperatives within this condition. Intercourse has now taken form, so one can see the potency equivalent of the interaction (feeding) towards impregnation (fulfilment). The process of the group going though these many stages is, indeed, a complex matter. Therefore, the resonance of the dynamics of fullness and emptiness when embraced helps us to understand, translate and interpret the interplay with the matrix and the pattern of the group.

Clinical illustrations Now I want to turn my attention to two sessions that highlight the theoretical formulations that I have addressed thus far. The space between the sessions is approximately two years. The first session is interesting in that the clients collectively refused to create pictorial imagery. Hence, the session was empty of concrete imagery, but the act of not painting or drawing was full of meaning. The second session showed a more clearly defined expression of powerful powerlessness. I shall confine myself to salient aspects of these two sessions rather than an in-depth exploration. Reflecting on Cortesão’s pattern, the particular analytical stance I took created an imprint and was parallelled by the emergence of more conventional patterns. In creating a structure that expected clients to enter the room


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and commence painting or drawing, and then move on to a verbal dialogue, a pattern imprinted with various meanings emerged. As Cortesão suggested, this did, on the whole, foment regression. However, on numerous occasions, the regression was of a highly negative structure and format. With these points in mind, I was often seen as a punitive, critical father (pattern), but on rare occasions I was experienced as a caring and benevolent paternal figure. Also, for a large proportion of the group’s life, I had a male co-therapist; this combination exacerbated such conflictual dynamics, i.e. a dominance of the male authority imprint. My style and recurring ways of intervening and interpreting added further substance to the pattern, à la Cortesão. I mentioned earlier that there needed to be a healthy intercourse between pattern and matrix; on reflection, it was the lack of this aspect that contributed to the dysfunctional components and the eventual failure of this group to thrive. Over time, the pattern had developed into a primarily negative form and as such was inhibiting the development of a healthy dynamic matrix. However, at times there were glimmers of hope for change, but these were short-lived. There were also times when the use of the imagery produced healthy creative growth within the frame of the paper, which was then converted to verbal dialogue. Reflecting further on these complex issues, one thing that was common for each woman in the group was a disastrous relationship with her mother. Therefore, the foundation matrix was damaged, which in turn undermined the potential for a fruitful, fertile dynamic matrix to develop. On a conscious level, the ‘group as a whole’ needed to keep the therapists at a distance and framed in a critical and negative light. This would prevent the intercourse between group (paternal) conductors and (maternal) group members. This was an inadvertent aggressive attack on their own internal mother images.

Session 1 Four clients were present for this session; one person was late. My co-therapist was present. When we came into the room, Mary, Ingrid and Hilary were sitting in the circle of easy chairs instead of being at the tables painting and drawing. My co-therapist normally sits in this circle while I sit in a chair between the tables and the easy chairs. This position is part of the developing pattern. When Harry came in late, he also went to the circle. In effect, this created a split between myself and the others in my attempt to uphold the pattern.

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It was clear that the ‘group as a whole’ had decided not to paint or draw. My colleague was also caught in this resistance. The group carried on speaking in a somewhat tentative manner while I sat for 20 minutes waiting to see whether they would come to the tables to paint and draw. My co-therapist was also silent. During this time, the group members were talking about superficial areas such as holidays. There was an expectant silence (note my earlier points on silence [empty of word] and expectancy [fullness] coinciding). Eventually, I knew that they would not paint or draw and I went to join the circle. It was clear that this was a statement of rebellion, which we began to focus on when I joined the circle. As the dialogue progressed, this rebellion was reflected in the difficulties the group had outside with conflict and the struggles with rebellion. Mary spoke about her battles with her husband, who kept rescuing their son from trouble without considering her. Hilary highlighted her struggles with her father, in which there was a battle to keep Hilary’s dog out of the house. This seemed to provoke her feelings that she and her dog were as one against her father. There was a sideways move when Harry spoke about his wife’s parents. He spoke about how his in-laws had rejected him and cut him out of family events. To be accepted by them, he felt that he had to conform to their expectations. This also seemed to reflect the struggle he had at the beginning of the session in going along with the group in not painting, thus setting him in opposition to me. Both here and with the in-laws, he conformed as he did in his primary school and at work. There was a further extension of Ingrid’s interactions with professional agencies who frustrated her. Generally, her frustrations were not satisfied, and she expressed disappointment and anger. Within the group context, these dilemmas were enacted in the battle with me and the group’s ethos. Within the life of the group, this seemed to parallel an adolescent stage in the group’s development. In my interpretive comments, I had acknowledged a genuine need for rebellion, especially considering the points they spoke of in relation to mothers. In previous sessions, there had been lesser acts of rebellion, with clear wishes to rebel, for instance, Mary had wanted to paint on the walls. This suggested not only a need to attack authority but also a need to have it in place in order to secure boundaries – the pattern. An intrinsic dynamic here seems to be a battle between the pattern (father) and the mother (matrix) on many levels. The rebellion within this session seems to be an enactment of such complex struggles.


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Session 2 The main theoretical formulation within this session was connected to my views on polar balances. However, the driving force of powerful powerlessness was present, leading to an expression of polar balances and the power of opposites. Two members were absent, leaving Michelle, Mary and Delores present. Figure 11.1 shows the artwork produced: Michelle: Set of scales. Mary: Drawing of a dream. Delores: Coloured squares and circles.

The group spent 30 minutes creating their imagery. When they began to speak in the verbal section, they focused strongly on the images produced. Michelle spoke first about her scales representing her attempts to balance

Michelle

Mary

Dolores


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her good points with her pessimistic views of life. Mary talked about her painting of her dream, which concerned her husband being involved with other women. In the dream, her son is holding her back physically. The struggle with her son had been a central point of exploration in previous sessions. In the dream, Mary eventually broke free from her son and got away. In real life, her son appeared to play out the go-between between Mary and her husband. When Delores went on to speak about her struggles with her husband in respect of his controlling attitude to her, the dynamics became clearer. Although she was not focusing on her imagery, she highlighted how she felt so controlled by him that she felt powerless to change this. The symbolism in her painting seemed to show an entrapment of one shape beside the other: Delores and her husband. I had elaborated on the numerical structure in the imagery of five people in the room; the group members responded that I often highlighted this area. This seemed to be another element within the pattern in that they were tuning into particular imprints that I was making, in this instance encouraging the group to expand their thoughts to include the relevance of numeracy.

Conclusion In conclusion, I believe that both of these sessions highlight specific features within a theoretical context. They bring to the fore predominant elements that are in dynamic flux between matrix, pattern and powerful powerlessness (as one derivative of fullness of emptiness). The first session speaks specifically about the dynamics of rebellion within these struggles. The second session emphasises the struggles with control and being controlled. Overall, the triad of pattern, matrix and fullness of emptiness are played out both in an elaborate unconscious sequence and as conscious states of expression and exchange. I hope that I have conveyed some clarity within a relatively complex area. Unfortunately, I have been restricted in the amount of space I could devote to clinical illustrations. However, if the reader studies the earlier parts of theory and adapts relevant points to the two sessions mentioned, as well as to their own clinical settings, the picture may become clearer.

Final remarks

I was saddened when I heard of the death of Elizabeth Foulkes, S. H. Foulkes’ widow. Elizabeth had been the guardian and editor of much of Foulkes’ work. I recall meeting with her in 1998 at her home in London in order to discuss the possibility of writing a student reference book that would highlight Foulkes’ theories and a Russian translation. Elizabeth was keen on the idea and suggested translating the whole of Michael’s (S.H. Foulkes’) first book into Russian. I felt honoured that she had agreed to my suggestions. I did not live up to that agreement in her lifetime, but I hope that my retirement will favour its completion. At one point, I asked Elizabeth if she felt that Foulkes would have approved of my adapting his ideas and methods to art groups. She replied: ‘Yes, he would: he loved art.’ Before this meeting, I recall attending the retirement party of Dr Vivienne Cohen, (my supervisor) at the Institute of Group Analysis. Elizabeth Foulkes was present, and I recall her speaking about Michael. Vivienne recalled her experience of being at the group meeting in which Dr Foulkes collapsed and died. As many eminent group analysts and students stood around listening to these stories at the party, another group analyst burst into the room, begging to interrupt with the news that the prime minister of Israel had been assassinated. The retirement party went into a state of shock. While speaking about the death of the originator of group analysis, the prime minister of Israel had died. This was especially poignant, as Dr Cohen was retiring to Israel. Once again, these were statements of things starting and ending at the same time. I trust that if there is an afterlife, I hope Michael and Elizabeth will look favourably on this book and I complete it as a final honour to their memory and especially to Dr Foulkes’ legacy of group analysis.

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Rothaus, P., Hanson, P. and Cleveland, S. E. (1966) ‘Art and Group Dynamics.’ American Journal of Occupational Health 20, 4, 182–7. Rubin, J. A. and Rosenblum, N. (1977) ‘Group Art and Group Dynamics: An Experimental Study.’ Art Psychotherapy 4, 185–93. Rycroft, C. (1968) A Critical Dictionary of Psychoanalysis. Harmondsworth: Penguin Books. Sandler, J., Dare, C. and Holder, A. (1973) The Patient and the Analyst: The Basis of the Psychoanalytic Process. London: George Allen and Unwin. Sara, N. (1998) ‘Connection and Disconnection in the Art Therapy Group: Working with Forensic Patients in Acute States on a Locked Ward.’ In S. Skaife and V. Huet (eds.) Art Psychotherapy Groups. London: Routledge. Schaverien, J. (1985) ‘Creativity and the Institution.’ Inscape, 1, 3–6. Schaverien, J. (1987) ‘The Scapegoat and the Talisman: Transference in Art Therapy.’ In T. Dalley, C. Case, T. Schaverien, F. Weir, P. Nowell-Hall and D. Waller Images of Art Therapy. London: Tavistock. Schaverien, J. (1989) ‘Transference in the Picture: Art Therapy for the Treatment of Anorexia.’ Inscape, Spring, 14–17. Schaverien, J. (1995) Desire and the Female Therapist: Engendered Gazes in Psychotherapy and Art Therapy. London: Routledge. Schaverien, J. (1999) The Revealing Image: Analytical Art Psychotherapy in Theory and Practice. London: Jessica Kingsley Publishers. Schaverien, J. (2000) ‘The Triangular Relationship and the Aesthetic Countertransference in Analytical Art Psychotherapy.’ In A. Gilroy and G. McNeilly (eds.) The Changing Shape of Art Therapy: New Developments in Theory and Practice. London: Jessica Kingsley Publishers. Scheidlinger, S. (1974) ‘On the Concept of the Mother Group.’ International Journal of Group Psychotherapy 19, 417–28. Sivod, H. (1964) ‘Communication through Paintings in a Therapy Group’. Bulleting of Art Therapy 3, 4, 133–147. Skaife, S. (1990) ‘Self-determination in Group Analytic Art Therapy.’ Group Analysis 23, 237–44. Skaife, S. (2000) ‘Keeping the Balance: Further Thoughts on the Dialectics of Art Therapy.’ In A. Gilroy and G. McNeilly (eds.) The Changing Shape of Art Therapy: New Developments in Theory and Practice. London: Jessica Kingsley Publishers. Skaife, S. and Huet, V. (eds.) (1998) Art Psychotherapy Groups. London: Routledge. Smail, D. (1984) Illusion and Reality: The Meaning of Anxiety. London: J.M. Dent and Sons. Sobol, B. and Williams, K. (2001) ‘Family and Art Therapy.’ In A. Ruben (ed.) Approaches to Art Therapy: Theory and Technique. Philadelphia, PA: Brumner/Routledge. Springham, N. (1998) ‘The Magpie’s Eye: Patients’ Resistance to Engagement in an Art Therapy Group for Drug and Alcohol Patients.’ In S. Skaife and V. Huet (eds.) Art Psychotherapy Groups. London: Routledge. Swan-Foster, N., Lawler, M., Scott, L., Angel, D., Ruiz, C. M. and Mana, M. (2001) ‘Inside an Art Therapy Group: The Student Perspective.’ Arts in Psychotherapy 28, 161–74. Symington, N. (1986) The Analytic Experience: Lectures from the Tavistock. London: Free Association. Teasdale, C. (1995) ‘Reforming Zeal or Fatal Attraction: Why Should Art Therapists Work with Violent Offenders?’ Inscape 2, 2–9. Trotter, W. (1921) The Instincts of the Herd in War and Peace. London: Ernest Benn. Vassiliou, G. (1966) ‘A New Approach to the Use of Free Artistic Creation in Group Psychotherapy.’ In J. L. Moreno, A. Friedman, R. Battegoy and Z. Moreno (eds.) The International Handbook of Group Psychotherapy. New York: Philosophical Library Publications. Wadeson, H. (1980) Art Psychotherapy. New York: John Wiley & Sons. Waller, D. (1993) Group Interactive Art Therapy: Its Use in Training and Treatment. London: Routledge. Wilhelm, R. (1968) The I Ching or Book of Changes (translation). London: Routledge and Kegan Paul.

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Williams, S., Tamura, A. and Rosen, D., (1977) ‘An Outpatient Art Therapy Group.’ Art Psychotherapy 4, 199–214. Winnicott, D. W. (1965) The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. Madison, CT: International Universities Press. Wolf, A., Kutash, I. and Nattland, C. (1993) The Primacy of the Individual in Psychoanalysis in Groups. Northvale, N.J: Jason Aronson Publishers. Wood, M. (1984) ‘The Child and Art Therapy: A Psychodynamic Viewpoint.’ In T. Dalley (ed.) Art as Therapy: An Introduction to the Use of Art as a Therapeutic Technique. London: Tavistock. Yalom, Y. (1970) The Theory and Practice of Group Psychotherapy. New York: Basic Books.

Further Reading Borowski Jung, M. (1994) A History of Art Therapy in the United States (with Pateracki Asawa). Mundelein, IL: The American Art Therapy Association. Glaitzer, H. T. (1965) ‘Aspects of Transference in Group Psychotherapy.’ International Journal of Group Psychotherapy 15, 167–76. James, D. C. (1982) ‘Bion’s Containing and Winnicott’s Holding in the Context of the Group Matrix.’ International Journal of Group Psychotherapy 34, 2, 201–14. Johns, S. and Karterud, S. (2004) ‘Guidelines for Art Group Therapy as Part of a Day Treatment Programme.’ Group Analysis 37, 3, 419–32. Jung, C. G. (1961) Memories, Dreams, Reflections. Glasgow: Collins Fount Books. Klein, M. (1975) Love, Guilt and Reparation and Other Works: 1921 to 1945. London: Hogarth Press. Klein, M. (1988) Envy and Gratitude and Other Works: 1946 to 1963. London: Virago Books. McNeilly, G. (1997) ‘Resonance and Intuition in Group Analysis and Group Analytic Art Therapy.’ Presented to the Brazilian/Portuguese Association of Group Analysis, Lisbon, Portugal. McNeilly, G. (2004) ‘Commentary: Guidelines for Art Group Therapy as Part of a Day Treatment Programme.’ Group Analysis 37, 432–4. Nitsun, M. (1996) The Anti-Group: Destructive Forces in the Group and their Creative Potential. London: Routledge. Pines, M., Hearst, E. and Behr, H. (1982) ‘Group Analysis (Group Analytic Psychotherapy).’ In G.M. Gazda (ed.) Basic Approaches to Group Psychotherapy and Group Counselling, 3rd edn. Springfield, IL: Chas C. Thomas Publications. Skaife, S. (1995) ‘The Dialectics of Art Therapy.’ Inscape 1, 2–7. Waller, D. (1991) Becoming a Profession. London: Routledge. Winnicott, D. W. (1949) Through Paediatrics to Psychoanalysis. London: Karnac/Institute of Psychoanalysis.

Subject Index Page numbers in italics refer to diagram. acting out 45 Adamson, Edward 29 aesthetic productions 197 Agazarian model 111 Alcoholics Anonymous 145, 147 alienation and encounter 147–8 anorexia and ‘emptiness’ 205–8 group anorexic ethos 212 images and transference 76 literature reviews 113 locating ‘centre of balance’ 146 and pregnancy 211 ‘anti-group’ (Nitson) 35 archetypes (Jung) 80–1 and symbolism 139–40 art as collective message 52 as therapy 164 see also imagery ‘art as healing’ (Adamson) 29 ‘art is therapy‘ (Bradbury) 29 Art Psychotherapy Groups (Skaife and Huet) 105, 117–18 art therapists 15, 57 with individuals in groups 56–7, 62–3, 71–2 main types 17–18 transference constellations, dealing with 80 see also therapists art therapy background 17–19 career opportunities 19, 21 directive 31–6 institutional aspects 19–21 key works 18–19 theoretical models 17–18

confusion and fusion dualities 195–7 Confusion and Fusion in Group Analysis (McNeilly) 196 congruence and divergence dualities in verbal vs. art groups 150–2 connection and disconnection (Sara) 118–19 consciousness, triangular configurations 128–9, 129 contagion theory (Le Bon) 56 ‘basic assumption pairing’ containment theories (Bion) (Bion) 137 115 Bionic model 99, 107–8 see also ‘holding’ Book of Changes (Wilhelm) content of groups, description 141 of 178–81 boundary issues, acting out convergence and divergence, 45 art groups cf. verbal Bruno, Frank 166 groups 150–2 counter-transference 79–81 Champernowne, Irene 114 definition 73 child development 161 triangular configurations child focus, in transference 128–9, 129, 132 constellations 75 creative space 59 client expectations 70–1, 183 and growing-up co-therapists 120, 213 211–12 Cohen, Dr. V. 217 and individuality 68–71 collective art 52 and intuition 156 see also ‘group as a creativity and intuition 156 whole’ curative factors (Yalom) 116 collective unconscious 132 as ‘condenser’ for group ‘Deep End of Group Analytic emotion 58 Art Therapy’ (McNeilly) and individuality 51 123–4 role in group analytic denial and projection 136 model 46 dependency behaviours ‘common group tension’ as defence against (Ezreil) 58, 107 contagion 56 community art groups 42–3 and direction 32, 34 ‘complex’, definition of 162 unresolved 58 complexities – subtleties – depth imagery 123–4 simplicity 161–4 Desire and the Female Therapist condenser phenomenon (Schaverien) 77 (Foulkes and Anthony) 58 destructive dynamics 58 confidentiality issues vs. see also conflict; bridging attempts 98 malignancy in conflict groups; polar attraction of opposites imbalances 139–40 dialectical relationships 118 about changing nature directive art therapy 31–6 of groups 44–5 background experiences and common group 31–2, 34 tension 58, 81–3 and dependency 32, 34 and group transference in group analytic art 81–4 therapy 34–6 see also opposing forces therapeutic settings 20–1 training courses 14–15 transference constellations 73–8 see also group analytic art therapy attraction and repulsion 137 see also opposing forces ‘autistic image’ 119, 142

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directive art therapy cont. literature reviews 106, 108 use of themes 32–4 ‘Dissonance and Harmony’ (Skaife and Huet) 117 ‘do it yourself ’ model (McNeilly) 132 dualities 195–7 see also opposing forces dyadic relationships 138 dynamic flows fullness/emptiness 208–10 in ‘group as a whole’ 186–8, 195, 200 ego dynamics 130–2, 131–2 ego-building in groups 113 emotion, collective 50, 58 emptiness see ‘fullness of emptiness’ ‘Encounter or Alienation’ (McNeilly) 139, 147–8 environmental settings see therapeutic settings envy and polar balances 142–3 vs. being envied 140 evoking and immersing 124 Experiences in Groups (Bion) 30, 56–7 experiential learning, literature reviews 106, 119–20 family therapy 111 fear of annihilation (Hopper) 86, 136, 164, 202, 212 fear of losing individuality 187 field theory (Lewin) 26 figure-ground (Foulkes) 178 Foulkes, S.H. background 24–5, 106 early influences 25 education and training 25 influence on training 99 legacies 217 literature reviews 105–6, 114 on group transference 83–4 on ‘group as whole’ 52, 188–9


content – process – structure 176–81 criticisms and responses 30 direction and themes 31–6 early papers 30 evolving terminology 30 foundations 46 goals 85–6 group structures 41–4, 178 ‘group as whole’ 49–67 ‘group as whole’ vs. parental frameworks 96–7 ‘individual in the group’ 68–72, 85–6 interpretation statements 66 key transference constellations 84 matrix and resonance 36–8 methodologies 45–7 patterns of patient behaviour 97–8 session evaluation 181–5 theoretical models and frameworks 64, 99, 128–33, 129–32 Gestalt therapy 27–8 training 98–9 Goldsmith’s College see also ‘group as a (University of London) 98 whole’ ‘good enough mother’ group analytic psychotherapy (Winnicott), and groups see group analysis 57, 72, 113, 150 group art therapy group analysis by the group 28 background formulations in the group 26–7 24–8 of the group (Tavistock comparisons with group model) 27 analytic art therapy group behaviour 150–1 basic principles 185–6 Foulkes’ definition 33 concept of ‘we’ 55–6, key constructs 25–6 149 personal learning and herd instinct 49–50, experiences 99 186 treatment approaches key works 49 26–8 opposing forces and Group Analysis (McNeilly) 31 attraction of group analytic art therapists opposites 135–8 see therapists and social contracts 55 group analytic art therapy see also ‘group as a background influences whole’ 29–30, 40 group culture 72 compared with group group dynamics analysis 150–2 background 26

on the individual as nodal point 167, 196 on intuition 157 on matrix 202, 208 on the ‘neurotic symptom mumbling’ 153 on normality and neurosis 166–7 and ‘The setting in the circle’ 133–4, 133 foundation matrix 132, 213 Foyle Hospital 93–4 frames of reference, parental dynamics vs. ‘group as whole’ 96 Freud, S. on id, ego and superego 125, 130 on ‘love’ and group phenomenon 53–4 on transference and counter-transference 73 ‘fullness of emptiness’ 204–12 and anorexia 205–8 dynamic nature 209–10 fullness of silence 210

SUBJECT INDEX

destructive forces 35, 58 nature and substance 50 and persecutory anxieties 60 transference 80–1, 81–4 verbal vs. art group representations 134–5, 134 see also group behaviour; ‘group as a whole’ group image therapy (Vassiliou) 107 Group Interactive Therapy (Waller) 105, 115–16 Group Process Made Visible (Riley) 111–12 Group Psychology and the Analysis of the Ego (Freud) 25–6, 49, 53–4 group resistances, literature reviews 109, 119 group therapy healing capabilities 35–6 treatment concepts 26–8 group transference 80–1 definition 83–4 hypothetical example 81–4 group vs. individual 139 use of Agazarian model 111 ‘group as a whole’ 25, 49–67 background 106–21 characteristics 50–1 definitions and perspectives 51–9, 59–61 development of ‘characteristics’ 72, 212 dynamic nature 186–8, 195, 200 emotional capacity 50, 212 group analytic approaches 65–6 group analytic definitions 59–61 location of the individual 51, 53–7 music analogy (Foulkes and Anthony) 52 as organism (Goldstein) 55 psychotic openings 169–75

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future hopes 57–8 narcissistic 209 pleasing 58–9, 197 purpose in ‘group as a whole’ 188 as transference objects 76, 78 and transition markers 101 triangular conceptual frameworks 125–30, 126–9 vertical and horizontal explorations 112 violent and frightening 58, 80 without dialogue 71 immersing and evoking 124, 179 hate and love 148–50 improvisation in Henderson Hospital interpretation 92 Therapeutic Community individual art therapy 28 approaches and models attention seeking as 40–1 defence 56 evolution of group vs. group 139 structures 40–4 group analytic sessions reactions to change 44 62–4, 66 herd instinct (Trotter) 49–50, negative consequences 186 34–5 ‘here and now’ configurations open art groups 41–2 27–8, 116 see also art therapy; hermits 186, 188 ‘individual in the History of Art Therapy (Hogan) group’ 29 ‘individual in the group’ ‘holding’, in context of 68–90 matrix 72 characteristics 68–9 ‘Human Nature in the Light creative space, of Psychopathology’ importance of 70–1 (Goldstein) 55 dynamic nature 186–8, humour in groups 115, 192 195 and interdependence I Ching (Book of Changes) 85–6 (Wilhelm) 141 literature reviews identity within groups 60 117–18 see also individuality motivations and imagery expectations 69–71 aesthetic productions new individuals in new 58–9, 197 groups 86–7 along complex – subtle new individuals in – simple established groups configurations 87–90 163–4 and psychosis 167–8 and creative space 70–1 therapist’s role 71–2 to express individuality see also 70 counter-transference; transference rubber band metaphor 191 study on specific imagery (McNeilly) 51 tapestry analogy (McNeilly) 50–1, 64 transference constellations 80–1, 81–4 triangular conceptual frameworks 64, 128–33, 129–32 and ‘valency’ (Bion) 54 ‘group as a whole inclusive of the individual’ 188–91, 191–5

226


individuality as consequence of group analytic process 85–6 within ‘group as a whole’ 51, 53–7, 187 see also identity; ‘individual in the group’ Inscape journal 105 The Instincts of the Herd in War and Peace (Trotter) 49 Institute of Group Analysis 133 interdependence and growth of individuality 85–6 interface space 138–40 interpretation along complex – subtle – simple configurations 162–3 comparing ‘verbal’ and ‘art’ groups 134–5 and improvisation 92 in new groups 185 verbal statements 66 Introduction to Group Analytic Psychotherapy (Foulkes) 29–30 intuition 153–4, 156–8 basic hypothesis 154–5 session examples 159–60 and wisdom 154, 158

psychotherapeutic treatment of groups 105–6, 114–21 loops of interaction 128–9, 128 love and attraction of opposites 138–9, 148–50 and group phenomenon (Freud) 53–4 and hate 148–50 of therapy work 179

Northfield Experiment (Harrison) 29 Northfield Hospital (Birmingham) 29, 40–1, 106, 114

object-centred group process (Azima et al.) 107 open art groups 41–2 ‘openings’ (McNeilly) concept explained 153, 165 and psychosis 165–75 opposing forces Males, Bruce 93 and attraction of malignancy in groups 209 opposites 135–8 matrix 202–3 dynamic flow 142 with art groups 36–8, Hopper’s fourth basic 134–5, 134 assumption 135–6 definition of 202 space at the interface in ‘group as a whole’ 59, 138–40 62 vignette (art group) literature reviews 140–2 112–13 see also conflict; polar and opposing force balances dynamics 137 ‘opposites attract’ 138–42 and pattern conjoint session examples 140–2 201–2, 204 ‘or’ 139 third dimension model The Organism (Goldstein) 25, 204–12 55 and transference Organized and Unorganized constellations 72 Group Mind (McDougall) triangular framework 49, 53 models 132 with verbal groups 36, pairing 181–3 134–5, 134 parental frameworks 72–3 methodology (group analytic therapist as father 213 model) 45–7 Journal of the Group vs. ‘group as whole’ see also matrix Analytical Society frameworks 96–7 McNeilly, Gerry 116–17 patient roles baseline models and ‘being-cared-for’ role influences 115–16 knowledge and intuition 154, 68–9 biographical details 158 ‘sick person’ role 69 13–14 pattern 97–8, 203–4 education and training definition of 203 language 124 14–15 and matrix conjoint and polar balances 143 mother role and groups 57, 201–2, 204 role in group analytic 72, 113 penal system and art therapy, model 46, 47 motivation 69, 70–1, 72 literature reviews 120–1 ‘Language of Dynamic music analogy (Foulkes and persecutory anxieties 60 Silence’ (McNeilly) 38 Anthony) 52, 147 play 150, 161 see also resonance mutuality requirements 69 polar balances 142–50 libido and opposing forces centre of balance 146–7 141 Narcissus 209 and imbalances 145–9 literature reviews 105–21 non-directiveness 35 key examples 144–5 normality and neurosis role of analyst 147 continuums 165–75 polar imbalances 145–9

SUBJECT INDEX

and fullness 210 possession 149 with individuals in pregnancy 211 groups 187–8 prison system and art therapy, and ‘polar balances’ 143 literature reviews 120–1 and sense of emptiness process of groups178–81 205 psychosis 165–7 therapeutic 207–8 ‘group as a whole’ see also resonance position 169–70 simplicity 162 individual position see also complexities – 167–8 subtleties – simplicity pyramid (three dimensional) Sisyphus 210 conceptual frameworks small group analytic art 130–2, 131–2 therapy groups 43–4 boundary issues 45 questions 200 methodologies and processes 45–6 regression 211, 213 reactions to change 44 resistances 135 structural formats 45–6 literature reviews 109, see also group analytic art 119 therapy; ‘group as a resonance 37–8, 153–4, whole’ 155–6 ‘Song of Being a Child’ basic hypothesis 154–5 (Morrison and Handke) examples in group 161 analytic encounters space at the interface 138–40 64–5, 159–60 space usage 148 and group valency 54 see also matrix; The Revealing Image therapeutic settings (Schaverien) 77 spiritual transference 83 risk-taking 179, 199 stereotypes 120 structure of groups 41–4, 178–9 sado-masochistic student art therapists, relationships 143–4 experiential learning 106, sarcasm and satire 115, 143 112–13, 119–20 scapegoat motif 76–8, 114 substance abuse and group art ‘The Scapegoat and the therapy, literature reviews Talisman’ (Schaverien) 76, 113 114 swan metaphor 123–4 seesaw metaphor 145–6 symbolic language self-determination concepts in ‘group as a whole’ 52, 117 59–60, 61–7 self-harming behaviours and literature reviews 106 art therapy, literature and resonance 38 reviews 113 synallactic collective image separateness 56 technique (Vassiliou) 109 see also identity; synapsis concept 196 individuality Sergeant Bradbury, S.L. 29 sexuality talisman motif 76–8, 114 and imagery 199 tapestry analogy (McNeilly), and sado-masochism in ‘group as a whole’ 143–4 50–1, 64 within therapeutic Tavistock model 27 encounter 120 themes in art therapy 32–4 silences 35–6, 37 literature reviews 110, and formlessness 135 115

227

therapeutic alliance, within ‘group as a whole’ 56–7 therapeutic pyramids 130–2, 131–2, 133 therapeutic settings 20 and creative space 68–71 therapists directive and non-directive roles 31–6 encounters with transference 80–1, 81–4, 100–1 experiential training 106, 112–13, 119–20 facilitating interpretations 65–6 improvising interpretations 92 as paternal figures 213 role in community art groups 43 role in group analytic art groups 57–9, 65–7 role in ‘group as a whole’ 56–7, 65–7 role with groups in conflict 147 role in ‘individual in the group’ 80–1, 84 role in open art groups 41–2 role in small group analytic art therapy groups 44 showing emotion 99 stress management 110–11 training courses (art therapy) including more group analysis 108 personal experiences 14–15 research into groups 106 and transitions 93–5 transitions and group analytic courses 98–9 transference 72–8 and art therapy traditions 73–8 British approaches 74–6 critiques 77–8 definitions 73 and directive approaches 31–2, 34–5

228


transference cont. by ‘group as whole’ 80–1, 81–4 image as object 76, 78 literature reviews 107 multiple 72, 78 mythical dimensions 80–1 need for psychoanalytic training 80 negative forces 81 non-acknowledgement 100–1 spiritual images 83 triangular configurations 128–9, 129, 132 types of therapy 84 within transference 77, 78 transitional space 92 transitions 91–102 definition of 91 patterns within groups 97–8 personal experiences 92–6 technical avenues 99 through developing perspectives 96 training avenues 98–9 understanding patient experiences 95–6 transpersonal paradigm 112 traumatized groups 136 triangles of conflict (Malan) 125 triangular frameworks 125–33 background and literature 125–6 complexities – subtleties – simplicity configurations 162–4 dynamic complexes 64 group analytic art therapy 128–33, 129–32 individual art therapy 125–8, 126–9 key omissions in art therapy 125 and transference 75, 78 trust, and being cared for 68–9

unconscious in group analytic model 46, 60 and intuition 157 and resonance 155–6 triangular configurations 128–9, 129 United States art group literature 105–6 see also individual authors ‘universal flux’ (Khan) 142 valency and group phenomenon (Bion) 54 verbal group analysis congruence and divergence issues 150–2 in ‘group as whole’ 66–7 matrix constructs 36 in new groups 184–5 pictorial representations 134–5, 134 violent imagery 58, 80 ‘we’, development of dual concept 55–6, 149 wisdom, and intuition 154, 158 Withymead Centre 114

Author Index

Gilroy, A. 105, 119–20 Goldstein, K. 25, 55–6, 149 Greenwood, H. 115

Agazarian, Y. 111 Angel, D. 112–13 Anthony, E.J. 38, 49, 52, 58, 83–4, 119, 139, 142, 155, 188–9 Armen, J.C. 185 Azima, H. 106–7

Hagood, M.M. 110 Handke, P. 161 Hanes, K.M. 105–6 Hanson, P. 107–8 Harrison, T. 29 Hearst, L. 24–8 Heimann, P. 79 Hogan, S. 19–20, 29, 114, 121 Holder, A. 73, 79 Hopper, E. 135–7 Howe, E.G. 205 Huet, V. 105, 111, 117–18, 121

Behr, H. 24–8 Belfiore, M. 110 Bion, W.R. 27, 30, 32, 34, 49–50, 54, 56–7, 99, 107–8, 135, 137, 169 Birchnell, J. 74–5 Blau, D.S. 154–5, 157 Boenheim, C. 107–8 Brady, P. 153 Byram Karusa, T. 207–8 Cleveland, S.E. 107–8 Cooper, B.F. 113 Cortesão, E. 201, 203–4, 208, 212–13 Crammer-Azima, F. 106–7 Dalley, T. 200 Dare, C. 73, 79 Dax, C. 29 Dillon Weston, M. 205–6 Dudley, J. 119–20 Durkin, H. 60–1 Ezriel, H. 58, 107, 138 Fordham, F. 141 Foulkes, S.H. (1957) 139, 155 Foulkes, S.H. (1964) 85 Foulkes, S.H. (1983) 25, 29–30, 35 Foulkes, S.H. (1984) 38, 49, 52, 58, 83–4, 119, 142, 155, 188–9 Foulkes, S.H. (1986) 33, 37, 132–3, 133 Foulkes, S.H. (1990) 157, 166–7 Freud, S. 25–6, 49, 53–4, 72–3, 125 Gazda, G.M. 28

Jacobi, J. 81 Jakab, I. 107 James, C. 72 Jung, C.G. 81, 132, 139, 141, 157, 208 Khan, C.H. 142 Kottler, A.J. 154–5, 157 Kutash, I. 208 Kymissis, P. 109 Lachman-Chapin, M. 108 Laplanche, J. 162 Lawler, M. 112–13 Layton, G. 115 Le Bon, G. 49 Lewin, K. 26 Liebman, M.F. 105, 116 Little, M. 79 Lomas, P. 157–8 Luce, J.V. 177 Malan, D. 125 Mana, M. 112–13 Mann, D. 77–8 Mayro, E. 111 McDougall, W. 49, 53 McLagan, D. 114–15 McLaughlin, M. 208, 211–12 McNeilly, G. (1983) 30–2, 36, 38, 75, 125 McNeilly, G. (1984) 30–3, 36, 75, 156 McNeilly, G. (1987) 38, 75, 91, 196

229

McNeilly, G. (1989) 36–7, 51, 59–60, 75, 143, 148 McNeilly, G. (2000) 105, 120, 130 McNeilly, G. (2003) 46 McNiff, S. 110 Milton, I.B. 113 Money-Kyrle, R.E. 79 Morrison, V. 161 Nattland, C. 208 Nitsun, M. 35 Pines, M. 177–9 Plaut, F. 75 Pontalis, J.B. 162 Potts, L.R. 106 Riley, S. 110–11, 111–12 Roberts, J.R. 38, 155–6 Rosenblum, N. 108–9 Rosen, D. 108 Rosen, M. 111 Rothaus, P. 107–8 Rubin, J.A. 108–9 Ruiz, C.M. 112–13 Ryecroft, C. 73 Sandler, J. 73, 79 Sara, N. 118–19 Schaverien, J. 76–7, 81, 114, 127, 131 Scheidlinger, S. 72 Scott, L. 112–13 Sivod, H. 108–9 Skaife, S. 105, 111, 117–18, 119–20, 121 Smail, D. 156–7 Sobol, B. 111 Springham, N. 119 Swan-Foster, N. 112–13 Symington, N. 146 Tamura, A. 108 Teasdale, C. 120–1 Trotter, W. 49–50, 186 Van Sweden 207 Vassiliou, G. 107 Wadeson, H. 74, 111 Waller, D. 105, 111, 115–16, 121 Wilhelm, R. 141

230


Williams, K. 111 Williams, S. 108 Winnicott, D.W. 57, 59, 113, 150 Wittkower 106–7 Wolf, A. 208 Wood, M. 75–6 Yalom, Y. 74, 116, 119, 138

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