Book Review: The Portuguese School of Group Analysis
Towards a Unified and Integrated Approach to Theory, Research and Clinical Work. (Routledge, 2021)
Edited by Isaura Manso Neto and Margarida França.
This book takes as its starting point the fact that throughout his career in England, Foulkes faced the problem that he was not only the self-appointed founder of a new form of group therapy with a ‘psychoanalytic approach’ but was also a member of the London Institute of Psychoanalysis, then a somewhat austere body with many members who viewed groups as the antithesis of psychoanalysis.
At the same time as Foulkes was developing his ideas in London, the Portuguese psychoanalyst, Eduardo Luis Cortasão, working in Lisbon, and a friend and contemporary of Foulkes, did not experience this dissonance to the same extent. Cortasão developed a fresh line of theoretical exploration and evolution that sought to integrate a fully psychoanalytic vision into group analysis – or groupanalysis as he preferred to call it – thereby giving ‘groupanalysis’ parity with the term ‘psychoanalysis’ – ‘a unique word which corresponds to his specific concept’ (The Portuguese School of Group Analysis. Neto and França, 2021, p115)
Personally, as a groupanalyst who began groupanalytic training in London over 40 years ago and who experienced first-hand the problems of integrating psychoanalytic thinking into the groupanalytic field, I welcome this book, narcissistically because much of the discussion closely matches my experience – and professionally because I agree with so much of it, especially my experience in clinical work with more severe psychopathologies. Due to the failure of public funding for long-term psychologically containing treatment, the normalising of pathological narcissism and the every-day presentation of severe pathologies such those resulting from complex trauma, the need for practitioners working in public and private practice to develop perceptive understanding with clear and coherent clinical acumen has never been more acute.
To simplify the sharp, detailed and depth discussions in this book, practice and clinical focus in groupanalysis would broadly divide on an emphasis on Foulkesian ‘ego training in action’ and a ‘psychoanalytic’ focus on transference, countertransference, classical defence mechanisms, drive theory, internalised object relations and so on. In the words of the Editors, they view group analysis as
‘It is a psychoanalytic treatment of the individual in and through the group.’ (ibid p.1).
and acknowledge that ‘it can also be used in other settings without therapy as its main purpose’ (my italics).
Eduardo Luis Cortasão ‘integrated four lines of thought found in psychoanalysis’ (ibid p.21) into his groupanalytic thinking; in brief:
• the metapsychological approach directly from Freud;
• object relations theory;
• Kernberg’s perspectives on narcissistic/borderline states;
• Self-psychology and perspectives on normal and pathological narcissism.
And, as the authors affirm:
‘It is our view that Cortasão drew attention to the action of the therapist (my italics) sparking the development of the groupanalytic process within the groupanalytic matrix’.
In other words, the action, or otherwise of the therapist depends on what they think they are doing.
So, what do we think we are doing? Discussions in Chapter 2 of the book assist in the work of addressing the ‘crisis’ in groupanalytic theory and practice that is related, in part, to ‘contradictions and ambiguities.’
Having been involved in training and supervising group analysts in the UK and abroad for many years, I have noticed that many qualifying course students, especially from the UK, find it difficult to articulate clearly exactly what it is that they think that they are doing when they think they are doing group analysis. Students say, “if we do Dynamic Administration again, I’ll scream”. One overseas student in a London IGA seminar group that I attended said, rather miserably, “I didn’t expect to come to the IGA to do a course in group counselling.” The ‘contradictions and ambiguities’ seem to be very alive.
The idea that you get your group together and maintain it with dynamic administration and ‘dialogue’ and magically it will produce great results is very prevalent, although balanced somewhat by awareness of ‘anti-group’ dynamics and sharp experience of what happens when you ‘trust the group’ when it is composed of people with severe personality disorders, delusions and addictions. Another prevailing idea, heavily influence by public perception, is that the group comes together to counsel each other in order to ‘solve’ whatever concrete presenting problems participants appear to be having in their outside lives – jobs, partners or lack of them and so on. The ability or inability or be able to describe what the groupanalyst does and why they do it has massive implications for the development or demise of groupanalysis within institutions and in the context of the public domain.
Neto and Centeno in a discussion on groupanalytic identity (ibid Chapter 2 p.28), amongst others, quote Harold Behr (2008):
‘The problem for group analysis is compounded by confusion in the public mind between the different forms of psychotherapy. There is a lack of definition which lends itself to the myth that group therapy, whether analytic or any other kind, is not a particularly specialised form of practice, that it can therefore be practiced by almost anybody who works in a clinical setting’.
There follows a lengthy collection and review of differing viewpoints and opinions, and concluding remarks that collect common features in to a ‘cluster’ and a ‘brand. (ibid p.51) I’m not sure how helpful this definition is as it could be used to validate muddled and unclear positioning and sounds like pandering to a kind of unpleasant consumerism and commodification, and reminds me of an ‘aggregation’. But overall, it’s a useful collection of perceptions that could be useful as discussion material in training.
Chapter 3, ‘The Portuguese school of groupanalysis’ (Ferro and França) is subtitled ‘the integration of psychoanalytic concepts in groupanalysis’ and provides a helpful discussion of this in theory and practice. Cotesão’s deep legacy is explored in some detail, with reflections and comments on connections with other notable theorists from Bion to Winnicott.
‘the internal object structure of each participant becomes evident and may be perceived according to one’s primitive object relations and the repetition of unresolved conflicts from the past in the here-and-now of the sessions; the traumatic events and relational patterns are experienced with the same emotional intensity as they originally were’ (ibid p.58)
and a colleague of Cortesão, C.V. Dinis, states that
‘groupanalysis operates as follows: the group is the means, each member’s analysis is the goal; likewise, the nuclear family and all the interpersonal and transpersonal sets to which the individual belongs throughout his life are the environment, while structuring identity and attaining autonomy is the desired outcome’. (ibid p.63)
Further chapters contain essential discussion of the relationship between the concepts of groupanalytic and personal group matrix, and the conception of a desirable group analytic meta-theory. Clinical vignettes, especially in Chapter 8, highlight and clarify the theoretical discussions. The importance of creating suitable settings for groupanalytic work is discussed in detail, as are the crucial areas of transference and countertransference, developmental process, and clinical management of multiple transference phenomena – ‘divided but not diluted’ – (ibid Ch7 p.127). Groupanalysis is rightly seen as a method of working with the very earliest locations of trauma and disturbance.
In a section entitled :’To see and be seen’:
‘By seeing the patient, the groupanalyst observes unconscious phenomena translated in facial expressions, gestures, body movement, etc. that might witness the affective charge of prelinguistic experiences from early stages of development of the mental apparatus…establishing an intensely empathic communication in a holding environment without which analytic labour would…become hostage to non-transforming intellectualisations and rationalisations.’ (ibid p.63)
The book ends with a return to the question of ‘crisis’ in groupanalytic societies due to issues of length of training, falling numbers of applicants for training, differing theoretical positions, the group analyst’s own analysis and experience as a patient, supervision and on-going clinical practice.
• • • • • •
This book will certainly help the determined student and practitioner, at any level, to refine, clarify and articulate the thinking and aims that support their practice.
The discussions of theory and the relation of theory to practice are intelligently described and argued in depth and might even impress the most doubtful of administrators.
Clinically, the activity/passivity of the analyst is a central theme and the type of leadership and clinical authority that the groupanalyst offers is discussed in some detail.
To end with a final quote:
‘Unlike Foulkes, Cortesão did not believe that the therapist is a simple group administrator…and attender in the interpretative process. The therapist is someone who moulds in the group a certain attitude of analytical listening…allowing the working through of the group transference neurosis’. (ibid p.23)
This book should be essential reading for students and practitioners of groupanalysis. It is researched and written with an admirable clarity, breadth, and depth of understanding, free-ranging and unrestricted. The Portuguese school, largely independently and autonomously, has developed a fascinating and fresh perspective, further evidence, if any were needed, that there are many aspects of groupanalysis and psychoanalysis that are universal, experienced, and repeated in different settings wherever we are. This creative developmental process is a favourable outcome of groupanalytic effort and inspiration.
References
Isaura Manso Neto and Margarida França (2021) The Portuguese School of Group Analysis: Towards a Unified and Integrated Approach to Theory Research and Clinical Work. Routledge
Bob Harris
bobharrispsychotherapy@gmail.com