Group analytic psychotherapy as therapeutic intervention in seropositivity

The first therapeutic groups were held in Boston during the first decade of the 20th century by J. Pratt, who began a series of “inspirational classes” for patients suffering from tuberculosis. The groups were short-term and their aim was to help patients manage the illness and adapt to it. As Pratt observed, bringing together people with the same problem and different strengths offers a sense of relief. Strong identification bonds are formed which unite the group, eliminating the feelings of isolation that the illness evokes. Today we recognize the phenomenon as a form of empathy and mutual identification that emerges from the shared process.

During the same period, in Washington, E. Lasell, a Freudian and later Jungian psychiatrist, started offering lectures to his patients on topics focused on the workings of the mind seen from a psychoanalytic viewpoint. He laid particular emphasis on the importance of bringing the fear of death and the conflict around sexuality into the social arena. He considered his patients capable of taking responsibility in understanding their symptoms and expected their active cooperation in the decision-taking process concerning their illness. He is the first group therapist to blend educational and analytic dimensions in group therapy.

Psychoanalysis was the first motor to drive the process of group therapy in the United Kingdom and two names most prominently associated with its development are those of W. Bion and S.H. Foulkes. The Northfield Military Hospital, where they worked, became the main treatment center in the U.K. for psychiatric casualties returning from the battlefields of the Second World War.

Long-lasting research and experience indicate that, within medical settings and as far as patients are concerned, group analysis, which examines the complexity of human experiences, can contribute to:

  • involvement of the patient in the therapeutic process
  • detection of problems
  • reduction of feelings of isolation
  • relief of stress
  • improvement of patient-medical staff cooperation
  • compliance of patients to therapy.

 

Apart from their role in health units, group therapists, and therapeutic groups for staff members, contribute to the optimal functioning of organizations as diverse as fire departments, civil services and schools. Rapid changes that characterize our time often evoke severe stress and resentment, and may endanger productivity and effectiveness. Group analysis, through its focus on human relations, seems appropriate to scrutinize and manage malfunctions of such kinds within organizations.

At the beginning of 2011, a new therapeutic intervention was introduced at the Counseling Center, which was addressed to all those who experienced HIV infection in their lives. Group analytic psychotherapy was offered to seropositive individuals and their significant others, as well as to staff members of the A. Syngros Hospital, the medical setting within which the Center is located. The main aims of this intervention were to explore the thoughts, feelings and behaviors that govern human relations, interactions and communications, as well as to share the necessary feedback and support in order for the individual to attempt psychological modifications in the way he/she manages the experience of HIV infection in his/her life emotionally, behaviorally and mentally. Patients responded promptly and two groups were formed which continue their therapeutic work today. Nevertheless, we should note that we did not enjoy the same response from the Hospital’s medical staff. No doctors or nurses applied. We consider their reluctance predictable. Wide-range research projects on relevant issues, as those issued by the Tavistock Institute of Human Relations, recognize within the functioning of social systems such as medical institutions, a defense against anxiety. More specifically, in the hospital setting, the medical staff suffers the overall, direct and concentrated influence of stress factors that are related to patient care and close contact with patients and their significant others. Treating and nursing people with incurable diseases is a distressing task. Medical staff members are confronted with the threat and the reality of suffering and death. The work situation arouses strong feelings of pity, compassion, love, guilt and anxiety. These elements influence the way that the structure and culture of the medical institution is organized. Stress avoidance is the mechanism most institutions practice in the face of the above challenges. Staff accomplish this by focusing obsessively on their medical and nursing tasks, disregarding their need for social and psychological satisfaction within the work setting, as well as for their support in stress management (Menzies Lyth, 1988).

The basic therapeutic aim of any form of psychotherapy may be considered to be the restoration of a sense of identity through the regeneration of autonomy, self-determination and ability to bear the uncertainty of life, rendering meaning to all that shatters it. Recent developments in the medical treatment of HIV offer to people diagnosed with it the possibility to focus on re-defining their lives, incorporating this new reality and assuming full responsibility of themselves.

In group analytic psychotherapy, therapeutic change happens within / through the group. According to its founder, psychological development as well as mental disorder and its treatment happen within a network of relations (Foulkes, 1948).

The theory of group analysis offers us, through group processes, an understanding of the link between individual and society, an in-depth view of the psychic mechanisms – especially those of denial, splitting and projection – that appear as defenses against fear and rage.

For the members of our therapeutic groups, the metabolism of their anger, shame, despair, loss and fear helps maintain the interpersonal and intra-psychic pathways of hope, trust and love of the self and the “other”. The supportive feature of group therapy helps members venture intense emotional expressions of an interpersonal nature. The consensus corroboration of co-members allows psychic movements of reality testing and recognition of inappropriate interpersonal feelings and behaviors. This time the “family-group” understands, accepts, deciphers, bears and contains all which the individual hasn’t been able to process. The “family-group” reflects, organizes and returns to its member the unprocessed material in psychologically manageable form, cultivating emotional consciousness. The ability for a deeper, more sincere interrelatedness is nurtured.

 

References
  1. Bion, W.R., 1961. Experiences in Groups. London: Tavistock Publications Ltd.
  2. Blechner, M.J., 1997. Hope and Mortality. Psychodynamic Approaches to AIDS and HIV. New Jersey, U.S.A: The Analytic Press Inc.
  3. Foulkes, S.H., 1948. Introduction to Group-analytic Psychotherapy. London: Heinemann.
  4. Foulkes, S.H., 1964. Therapeutic Group Analysis. London: Allen and Urwin.
  5. Foulkes, S.H., 1986. Group Analytic Psychotherapy – Method and Principles. London: Karnac Books.
  6. Gilman, S., 1998. The iconography of disease in: AIDS: Cultural Analysis / Cultural Activism. Cambridge, MA: MIT Press.
  7. Hinshelwood, R.D., Skogstad, W., 2000. Observing Organizations. Anxiety, Defense and Culture in Health Care. London: Routledge.
  8. Menzies Lyth, I., 1988. Containing Anxiety in Institutions. Selected Essays. Vol. I. London: Free Association Books.

 
Maria Gounaropoulou, Psychologist, Group Analyst
Counseling Center for AIDS
Department of Community Interventions

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