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 consolida-tion 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 psy-chology and general systems theory. The man who was chiefly respon-sible 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).
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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 develop-ment was that of the neurologist Kurt Goldstein (Goldstein 1939) whose assistant he was for two years. Goldstein emphasized the impor-tance of the whole organism and its relationship to the total environ-ment. How much Foulkes was influenced by this view, and his applica-tion of it to the field of group analysis, can be seen from the introduc-tion to his monograph of 1948: ‘The healthy organism funcintroduc-tions 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
EARLY FORMULATIONS AND DEVELOPMENTS 25
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 com-munications 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 relation-ships are especially applicable to group analysis, with its emphasis on com-municative 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
psychoanalysis in groups as comparable. One difference may be that the art therapist would not necessarily align himself with the classical psychoana-lyst’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 essen-tially 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 chan-nelling 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 struc-tured 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 con-nections 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 environ-ment 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 insig-nificance. I will now discuss the group analytic art group in more detail.
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.
EARLY FORMULATIONS AND DEVELOPMENTS 29
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 paint-ings.
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 theo-retical 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.
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 modali-ties, 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 per-colate 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-EARLY FORMULATIONS AND DEVELOPMENTS 31
ships in the art group. On the whole, the lines of communication were
ships in the art group. On the whole, the lines of communication were