Co-constructing Hope in Group Analytic Psychotherapy: Relational and Group Analytic Perspectives

Taken from a panel presentation “Imagination and Hope in Relational and Group Analytic Perspectives” at the annual conference of the International Association of Relational Psychoanalysis and Psychotherapy (IARPP), “Imagining with Eyes Wide Open: Relational Journeys” in Tel Aviv, June 2019

Conceptualizing Hope

Many patients enter therapy with a wish to change something in their lives, yet they may not have faith that this can happen. This lack of faith, or disbelief is often re-enacted in the consulting room, leading to an impasse, and despair. Thus, the emergence of ‘hope’ in the therapeutic process is often a point of change.  I will endeavor to explore this further in this lecture.

Hopper (2003) points out that “although the word ‘hope’ has various connotations, ‘desirous expectation’ is the common denominator of them all”. (123). ‘Hope’ always refers to the future and is “a way of feeling, thinking, behaving, and relating to the self and others”. (123). He suggests that in development and the psychotherapeutic process, hope is

”…the willingness and ability to exercise the transcendent imagination in an attempt to overcome obstacles to the fulfillment of desirous expectations. Thus, hope is always associated with resilience, tenacity, fortitude, and a degree of realistic optimism, which are forged through the transmuting internalization of good enough relationships with one’s primary objects … On the basis of these virtuous achievements, a person is able to imagine possibilities for making creative use of traumatic experience”. (128)

While not clearly stated, hope is implicated in most analytic theories, from classical ones to current relational thought (Cooper 2016, Hopper 2003). To gain hope one must overcome transference repetitions of painful past relationships, and fear of giving up restricting, yet well-known, old relational patterns. One must also cope with perceptions of the analyst as a ‘new object’, which includes both ‘good’ and ‘bad’ aspects. No object can be felt to be real unless it has both benevolent and disturbing aspects, and real hope cannot emerge without meeting both aspects (Berman 2012, Cooper 2016). Both patient and analyst enter the analytic process with their own hopes (and fears) of that which may happen (Mitchell 1993).  These hopes are negotiated and transformed during the analytic process. Both must give up some of their (old) hopes in order to create new ones, which reflect better, more realistic possibilities.

Hope, the perception of time and the unfolding of the self and its interactions

Mitchell (1993) and Bromberg (1998) conceptualize the self in temporal terms. It follows that the self is a changing entity, with multiple self-states being created and transformed again and again in the context of relationships. Continuity and discontinuity of self-states, repetition and renewal of self-experiences, determine how one perceives and recognizes himself, or feels they are perceived by others. This also applies to the analytic process, in which rituality provides a rhythm of safety, a known background against which new experiences spontaneously emerge (Hoffman 1998; Messler Davies 2018).

Of special relevance to the subject of hope is one’s experience of oneself as authentic, meaningful, and alive. Mitchell (1993) suggests that authenticity is a feeling state, dependent on the “relationship between what I feel and do, and the spontaneous configuration and flow of my experience at that point in time. A particular act of self-expression… may feel extremely authentic at one point and extremely inauthentic at another.” (p 130-131). Authenticity is experienced in those minutes during which one can express oneself spontaneously, feel agency, and find congruency between one’s internal emotional state and the external interpersonal context.

This suggestion is reminiscent of Daniel Stern and the Boston change process study group’s concepts of ‘moments of meeting’ and ‘fittedness’ (1998, 2002). These are heightened moments in which the mother-infant or patient-therapist dyads are attuned to each other and feel deeply understood. Such ‘moments of meeting’ lead to feelings of safety and implicit learning of ways to be with others, which are then internalized. However, most of the time the parties to the dyad are casting about, engaging in an unsynchronized search for ‘fittedness’. This movement between ‘fittedness’ and ‘unfittedness’ is necessary for new, unknown ways of being together to emerge.

Taking these notions further, Seligman (2016) explores the relation between such minute interactions, and the subjective experience of time. He points to the importance of the caregiver’s responsiveness to his child’s gestures. This responsiveness enables the child to recognize its influence on another person and the changes it induces from one minute to the next. That is, constructing a future.

Seligman (2016) suggests two types of ‘temporal disorders’. In ‘Disorders of Simultaneity’, differentiations between past and present are lost and are projected into the future. This is common in post-traumatic states, in which trauma is felt to repeat itself in the present and is expected to recur in the future. ‘Disorders of Subsequency’ are the outcome of growing up with unresponsive caregivers. The child who does not have a chance to recognize his influence on his caregivers, grows up to become a person who cannot anticipate the existence of a possible future. Hopelessness prevails with a sense that nothing that one does really matters, and nothing can really change.

Schwartz Cooney (2018), and Aron and Atlas (2016), recently attempted to delineate a progressive, future oriented aspect of psychoanalysis. Attending to minute interactions in the analytic dyad, they conceive of enactments as emotionally engaged co-constructions of new possibilities. These enactments are attuned moments in which the analyst “reaches out to ‘reclaim’ severely disturbed patients, drawing them from states of near psychic-death into live contact” (Schwartz Cooney 2018, 340). They serve as rehearsals of future possibilities of relatedness. These enactments do not necessitate interpretation, as their emergence alone strengthens patients’ sense of agency, transforming passive ‘fatedness’ to ‘destiny’.

These ideas are an expansion of the spontaneous side of the dialectic that Hoffman (1998) describes between rituals and spontaneity. It is the same person, the analyst, who must asymmetrically hold both aspects … discipline, and a certain degree of ‘letting go’.  Group analytic therapy adds a symmetrical dimension to this process, that is free spontaneous interaction between the group members. This leads to a ‘flow of enactive engagement’ (Grossmark 2015), revealing old dissociated relational patterns as well as constructing new, future directed ones and practicing them.

These conceptualizations are in accord with Foulke’s (1964) concept of ‘ego training in action’ in which “The group provides a stage for actions, reactions, and interactions within the therapeutic situation which are denied to the psychoanalytic patient on the couch” and in which the ego is “activated and reformed” (82). Brown (1994) broadens this concept, describing the group process as a spiral in which one can discover: a. how he experiences others in terms of his internal objects; b. find out how these experiences can be transformed by new experiences created in the here and now of the group; c. learn to be more attuned to other people’s experience and one’s own and find new meaning in these. This means becoming able to take part in the creation of new ‘moments of meeting’ in which there is a ‘fit’ between inner and outer experience. Such moments serve as a safe base from which a member can dare to initiate spontaneous communication, which feels ‘unfitted’ to him and to others but can later lead to new integration in the group. In creating movement from ‘unfittedness’ to ‘fittedness’, this member comes to know her agency, affecting the group as-a-whole as well as one’s own sense of authenticity and aliveness. These are hopeful moments. Balanced with some failures to induce ‘fitted’ communication, such hopeful moments lead to a mature hopeful attitude in which both limitation and possibility are recognized.

Clinical vignette

This is a dynamic group conducted twice a week in a psychiatric ward. The group begins with a prolonged silence. Then Saul, an inhibited young member who usually does not speak much, begins to talk. He tells the group how he and other two members have playfully ‘acted like fools’ near the hospital fence, being watched by people standing outside. “They thought we are crazy” he says, splitting his sides laughing. The whole group, including the conductors, begin to laugh. This is felt as a moment full of life, where the people feel connected, yet wild, and maybe exaggerated, as well.

As the laughing ends, Saul says he is a bit ashamed. Maybe he dragged others in with his behaviour and laughter, and as a result they might not wish to be with him anymore. “Usually I don’t behave like this”, he says. There is silence again until Dalit begins to speak. Dalit is a woman in her 20’s, who is trying to cope with self-destructive sexual behaviour. Feeling ashamed of her behaviour, she does not usually speak in the group. “I want to find out whether I can speak here, especially after such laughter”, Dalit says. She tells the group how a close friend of hers has cut her off, and how painful it is for her. Sara, another young woman, describes how difficult it is for her when someone wants to befriend her while she doesn’t wish this to happen. “It happens a lot”, she says, “and that is why I avoid connecting with other people”. The conductor mentions that ‘here, in the group, there have been moments in which members rejected each other, and it was hard’.  Samira tells Dalit how she felt rejected by her in the previous session. Dalit replies that she knows that Samira was hurt by her in the past. “However, in previous sessions, when it happened, you shouted at me and threatened to beat me”, Dalit says. “Now you speak in a different manner and I can relate to you”. Samira says that she is going to be discharged soon, and she feels she has changed. Abraham, a man in his 20’s who is extremely shy and struggles with sexual desires which he finds hard to manage. He says that this is why he prefers going to prostitutes rather than have relationships with women. “If I pay, I can do whatever I want and don’t need to deal with their reactions toward me”. It is hard for the group, of whom some were sexually abused in their past. However, they listen to him attentively and he is not rejected. As the session reaches its conclusion, Dalit says she is proud of herself for speaking, especially after the laughter at the beginning of the group.

Discussion

The session began with a prolonged silence. Then, Saul initiated dialogue that began with a description of a playful moment outside, in front of a ‘normal’ audience. The play near the fence encompassed pain, embarrassment, and rejection which was felt due to being considered ‘mentally ill’. However, it also contained, and actually enacted a desire to feel free, alive, and accepted. As it was related with playful laughter, this desire was re-enacted in front of the group and its ‘normal’ conductors, bringing everyone in together, to create a desired scenario of acceptance. It was a ‘moment of meeting’, initiated by an inhibited individual, who mustered the courage to let the group see a different, playful, and humorous self-state of his, as well as to feel his own agency and his effect on the group.

While the laughter touched everyone and was felt to unite the group, it also stirred up shameful feelings, as the excitation was perceived as too strong. By mentioning his shame and fear of rejection in the group, Saul expressed his movement (and the group’s movement) from the experience of ‘fittedness’ to ‘unfittedness’. This led to silence. Then, Dalit resumed the conversational flow. She knew her voice might be unsynchronized, but she took the risk. It was the connectedness felt while the group was laughing, as well as seeing Saul’s sharing, as well as his playfulness, shame, and fear of rejection, that enabled Dalit to express herself. In a constructive way, new to her, she affected the ‘self-state’ of the whole group, which moved from excitation, embracement, and withdrawal, to attentiveness and reflectiveness, holding desire, shame, and rejection together in mind. Now, the group members were willing to discuss memories of rejection and avoidance of contact with others. Reflecting on the existence of such moments in this same group, the conductor facilitated the emergence of new poignant ‘moments of meeting’ as members spoke about inattention among themselves. The honest, open, dialogue between Dalit and Samira about the way they treated each other felt authentic, as they both expressed themselves spontaneously in a way congruent to the group talk. Following that, the whole group could listen empathically to Abraham’s uncensored, frank description of his sexual choices, in a way that had not occurred previously. One could think of Abraham’s provocative discussion as an enactment of dissociated hateful fantasies towards women and fear of being excluded from this connecting group. However, it can be seen as embodying a wish to be accepted, to which the group responds unconsciously, by staying attentive to him in spite of the content he raises.

I find it most important to relate to the way Dalit concluded the meeting. She recognized her newly acquired ability to cope with ‘unfittedness’ and initiated a dialogue, affecting the whole group. This is a hopeful moment, in which she discovers her agency, her ability to withstand stress and her positive contribution. She can begin to imagine a different future. In expressing the group’s voice, she speaks of the experience of others, as well.  (Indeed, she did very well in her rehabilitation later on).

Conclusion

This example shows how group members and the group’s conductors, enact and co-create new ways of being in the group. As the group moves between self-states, so do its members. While the group moves between ‘unfitted’ moments to ‘fitted’ ones, its narrative is constantly changing. In Brown’s spirit, we can see how a known experience of shame, self-destructiveness, and avoidance, is transformed by a new experience of vitality and constructiveness. In this way, I would suggest that, “…the willingness and ability to exercise the transcendent imagination in an attempt to overcome obstacles to the fulfillment of desirous expectations” (Hopper 2003, 128) is strengthened. That is hope.

Thank you

References

Aron L. & Atlas G. (2015) Generative Enactment: Memories from the Future. Psychoanalytic Dialogues, 25:3, 309-324

Berman A. (2012). ‘The Bad Enough Group Analyst’: Authenticity and Emotional Responsiveness in Group Analysis’. A Response to Farhad Dalal’s Foulkes Lecture. Group Analysis 45(4), 437-449

Bromberg P. M. (1998). Standing in the spaces. Essays on clinical processes, trauma and dissociation. New Jersey and London: The Analytic Press

Brown D. (1994). Self-development through subjective interaction: a fresh look at ‘ego training in action’. In: Brown D. and Zinkin L. (Eds.). The psyche and the social world. Developments in group-analytic theory. London and Philadelpha: Jessica Kingsley Publishers

Bruschweiler-Stern N. et al (2002). Explicating the implicit: The local level and the microprocess of change in the analytic situation. International Journal of Psychoanalysis. 83. 1051-1062

Cooper S. (2016). Revisiting the analyst as old and new object: The analyst’s failures and the therapeutic action of psychoanalysis. In: Cooper S., The analyst’s experience of the depressive position. London and New York: Routledge

Foulkes S.H. (1964). Therapeutic group Analysis. London and New York: Karnac

Hoffman I.Z. (1998). Rituals in spontaneity in the psychoanalytic process. A dialectical-constructivist view. New Jersey and London: The Analytic Press

Grossmark R. (2015). Repairing the irreparable: The flow of enactive engagement in group psychotherapy. In: Grossmark R. and Wright F. (Eds.) The one and the many: relational approaches to group psychotherapy. New York and London: Routledge

Hopper E. (2003). On the Nature of Hope in Psychoanalysis and Group Analysis. In: Hopper A., The social unconscious. London and Philadelphia: Jessica Kingsley Publishers.

Messler Davies J. (2018). The “Rituals” of the Relational Perspective: Theoretical Shifts and Clinical Implications. Psychoanalytic Dialogues, 28:6, 651-669

Mitchell S. A. (1993). Hope and dread in psychoanalysis. New York: Basic Books

Seligman S. (2016). Disorders of Temporality and the Subjective Experience of Time: Unresponsive Objects and the Vacuity of the Future. Psychoanalytic Dialogues, 26:2, 110-128

Stern D.N. et al (1998). Non-Interpretive Mechanisms in Psychoanalytic Therapy: The ‘Something More’ Than Interpretation. International Journal of Psychoanalysis, 79:903-921

Schwartz Cooney A. (2018). Vitalizing Enactment: A Relational Exploration. Psychoanalytic Dialogues, 28:3, 340-354

Ido Peleg, MD
‘Mazor’ Mental Health Center, Akko, and the Israeli Institute of Group Analysis
pelegidomd@gmail.com