Lessons from the COVID pandemic and the social unconscious: The impact on therapy groups
Presentation (Saturday, 2 October 2021) for the Greek Symposium on Relational Psychoanalysis and Group Dynamics
We live in unpredictable and unprecedented times: Difficult social processes, a dangerous pandemic spreading everywhere, and the disastrous consequences of climate change join together at the same period of time to create high anxiety, social and political unrest and severe distress around the world. All these troubling processes are intertwined. They are triggered by unconscious social processes and at the same time impact our unconscious mind in the long run. Group therapy and its applications seem to be a good panacea to this public unrest however its delivery is also influenced by these phenomena, and it should be adjusted to the current circumstances. In this presentation I will analyze these processes, the unconscious elements behind them and their impact on our unconscious mind. I will relate to the way that group therapy has changed and is influenced by those processes, especially the pandemic. I summarize by suggesting how we as group therapists can contribute to more global collaboration. [1]
Social Processes & the 4th Basic Assumption
Even before COVID-19 took over, the world was changing dramatically and quicker than ever. The waves of immigrants that flooded Europe and the fear of immigrants in the USA created a new global situation, destabilizing the secure order and evoking a feeling of unsafety. Deprived of safety, people legitimately feel alienated, distrustful, and isolated. Many Western countries face a difficult dilemma between the need to protect their boundaries and maintain security, and between the care for the immigrants, plenty of them are suffering refugees. Politically, nation after nation, this situation became a fertile ground for the rise of populistic movements and of right-wing, sometimes non-democratic leaders. Some of the social dynamics was a backlash against the tyranny of the “politically correct” atmosphere and the highly educated folks who accrued significant economic, cultural and political power. Thus, polarization and splitting became ubiquitous. In the Social Large Group (Volkan, 2004) the 4th Basic Assumption, described by Earl Hopper (2019) as a pendulum shift between Massification and Aggregation, governed the scene.
These powerful dynamics are manifested in many of the groups that I lead: People either feel isolated, rigidly protecting their own boundaries, focusing on taking care of their own needs, totally ignoring the interest of the group, or they massify in a way that melts personal boundaries, following charismatic narcissistic leaders and giving up individual thinking. The traumatic conditions of the COVID-19 pandemic and the “smell of death” in the air, only increased the oscillations between these two poles. In the USA, the emphasis on individualism, which is already deeply rooted in the foundation matrix of North America, only increased, and too many people ignore the good of the many in favor of their selfish needs. At the same time, people give up their critical thinking and massification is manifested in “group think”.
Example from an international forum for group therapists (whose purpose is to discuss group therapy issues) that I moderate: One of the participants wrote a post blaming another member for abusing a member of the therapy group that this other therapist leads. Apparently, s/he heard about it in another forum from the client who have complained about this therapist. S/he did not check the validity of that claim and posted it as a fact. The blamed group therapist explained that this issue was brought to the ethical committee of his professional board and was dismissed as untrue. I related to that blaming post as an unethical message and as a libel. After consulting some of my colleagues, I decided to suspend the person who posted it from the forum’s communication until s/he apologizes. A subgroup of forum participants attacked me for taking this action (intended to protect the safety and professionalism in this professional discussion group) claiming that this is an authoritarian act.
The same dilemma, between protecting the safety of the citizens by establishing restrictive rules (lockdowns, requirement for wearing masks, allowing only vaccinated people to enter public gathering) and guaranteeing the freedom of the people to decide about their own actions regarding their health, is in the center of the public debate around the pandemic and how to control it.
The pandemic and its consequences
The Covid pandemic, already with us for more than a year and a half, created havoc all around the world, affecting the world of psychotherapy as well. Therapists had to shift to “virtual” meetings without any preparation or training within days. The danger of physical proximity because of the virus, and the lockdown that followed the epidemic in many countries, forced therapists to shift to “screen relations” (Russell, 2015). Therapists that never imagined that they would ever get close to online therapy found themselves doing it daily. In the field of group psychotherapy, the situation was even more complicated. In the past, the idea of online groups was almost blasphemous. Most of my colleagues vehemently objected to conducting online groups, claiming that it is impossible to create the same group connections, presence, cohesion, and dynamics online as it occurs offline. The only caveat was that they never experienced it. Their resistance was based purely on their fantasy.
When the pandemic erupted, group therapists were pushed to conduct groups over the Internet. Indeed, in some countries authorities and health insurance companies doubted whether this modality is secure or effective enough. However, in most countries, group therapists who shifted to conduct groups on the screen were surprised to find out that it is no less powerful than face-to-face (f2f) groups. Since I am considered one of the experts in the field of online groups, following my co-edited book “Theory and Practice of Online Therapy” (Weinberg and Rolnick, 2020), I received several emails from senior colleagues expressing their surprise and excitement about these groups.
Research about individual therapy online has already accumulated before the breakout of the pandemic, showing that therapeutic alliance, the factor that is highly correlated with positive outcome in therapy, is possible online (Simpson and Reid, 2014). In my review of research about online groups (Weinberg, 2020) I pointed out that current research about online individual therapy is quite optimistic, but that studies about online groups are still missing. This gap will soon be closed as there are several studies about those groups running nowadays.
In my opinion, even when (or if) the vaccine for COVID-19 eliminates the pandemic and life returns to what is considered normal – online groups are here to stay. Their legitimacy increased dramatically following the world crisis, and although they have their limitations, some of their advantages (e.g. the comfort of connecting from home, no traffic jams, the fact that the therapist does not have to be local and can have clients from other places) are very tempting. In the coming future more groups would be conducted online, and more specific research (e.g. is online group cohesion the same as offline group cohesion?) will be carried out about them. The pandemic clearly legitimized online group therapy and it’s probably going to stay as another equal modality for providing therapy, and not a less valued one.
Cyberspace and the sense of Self
Moving to online therapy and group therapy fits well with the fact that the Internet became an integral part of people’s life. The impact of this technological revolution on our psyche is still not understood or researched enough. What does it mean for people to be able to rise above human limitations of time and space and connect with people around the globe with the click of the mouse? How do we adjust ourselves to a disembodied environment and how do we stay human when the “Other” becomes two dimensional (if we connect through video) or even a unidimensional (when we connect through text alone) abstract concept? The group matrix, that so far included dimensions such as norms, values, communication and relations, is expanded to include the technological dimension nowadays (just as for Karl Marx, technology exemplifies the interaction between human beings and nature). This dimension evokes associations and unconscious fantasies, so perhaps we might even have a technological unconscious.
Anyway, the idea of the self, that in the past was clear, centered, well-defined and focused, shifted to a decentered, vague and multi-facet concept. Our self can appear differently online and offline. Different self-states can show themselves in online relationships and online groups. The non-existence of the body in Cyberspace enables exploration of postmodern ideas that so far had no way of being tested. The ability people have online to create different characters, play several roles, change their age, appear as another gender clearly demonstrate the multi-facets of the self and of subjectivity. It seems that without being connected to their bodies people can explore more possibilities of the self and their subjective experience in ways that were blocked for them before the Internet era. It brings an understanding of human subjectivity as a partial, polymorphous and adaptable phenomenon. How this decentered new self affect group work? It still difficult to predict.
Keyword: Flexibility
One of the main factors that impacts online therapy and its outcomes, is the question of flexibility. If we stop being obsessed by the question how much online groups are similar to in-person ones (a mistake that many of my colleagues still make) and acknowledge that it is NOT the same as in-person therapy, that the setting is not controlled and structured by the therapist, that failures of communication are inevitable, that it’s difficult to establish conditions of safety and a holding environment, we have to flex the usual rigid boundaries and rules of conservative psychotherapy. Perhaps this is the main threat for more traditional therapists, since immediately the question that might pop up is: “how flexible we should become?”
Here is an example: A client participating in an online group seemed quite constrained and quiet for a long time in the group sessions. When the group inquired what is happening to him and why he is so quiet and passive, he revealed that he is having serious problems in his marriage, but since he is connecting from home and the walls in his house are thin, he does not feel that its safe to talk about his intimate issues and difficulties in his relationship with his wife when she is behind the wall. The group therapist (me) suggested that he will go to his parked car and connect from there.
This simple example shows that if we want to adjust ourselves to the new conditions of online group therapy, we must be flexible, especially regarding the setting and boundaries of the group sessions. This flexibility negates the long tradition of psychodynamic psychotherapy which assumes that the therapist should establish rigid boundaries in order to guarantee a better holding environment. First, we should be aware that online, at least half of the setting is determined by the group members (for example, we cannot choose the same chairs for the group circle and thus it immediately impacts the topic of equality and privileges in the group), so we cannot strictly attach to the old notion that the group therapist is the only one controlling the setting. It means that we share responsibility with the group members for creating the safe environment, recruiting their ego functions and strength and preventing some deeper regression. Collaboration becomes the factor for the group success. All these factors should be taken in consideration when we move to online groups.
Rupture and Repair
Lately, there has been an increase in the number of articles relating to the topic of rupture and repair in therapy and specifically in groups. The latest special issues of both the International Journal of Group Psychotherapy and Group Dynamics (edited by Cheri Marmarosh) focus on this topic. Some of the articles connect this topic to the therapeutic alliance. In my opinion, since human beings are prone to make mistakes, there will always be some ruptures in our therapeutic alliance, and the important issue is not to be perfect, trying to prevent them, but to focus on repairing them when they happen. I would dare saying that focusing on repairing empathic failures and mistakes in therapy is more powerful in the therapeutic process than intellectual interpretations, since they touch a deep unconscious wish that our parents would acknowledge and apologize for their mistakes and unattuned responses from our childhood. By the way, many times apology is not enough to repair a deep rupture, and it can also be expressed or perceived as lips service or social norm with no deep meaning.
Moving to online therapy, the group therapist immediately faces a lot of challenges, many of them seem technical ones. Interrupted Internet connections, freezing video, time gap between lips movement and the voice, difficulties to focus and be present, are some of the obstacles that affect online therapy. The failing technology is tiring, distracting, disappointing, and frustrating. However, if we look at it as another kind of psychological rupture, we can change our view of these failings and see them as opportunities for repair. In fact, the online modality allows for more opportunities to work on repairing ruptures than f2f meetings.
The question to follow is when is repair impossible? In the technical aspect, there is of course a moment when you cannot resume the internet connection when it breaks down. However, you can still bring the topic of failure to discussion the next session, exploring the impact of this rupture and finding a way to make amends.
You might find my next association a little bit farfetched, but I am thinking of the issue of global climate change and whether it’s too late to repair what we’ve done to Mother Earth. Many people are more and more convinced that we’ve done something terrible to our world, and that the long-term impact of decades of ignoring it might be irreversible. Some people ignored it due to denial and some because of a cynical interest to exploit natural resources without considering the impact on the good of the others (another example of aggregation and singleton phenomenon).
What can be done?
From group therapy research we know that the main factor contributing to positive group outcomes is the group cohesion. I assume that we can learn from this finding how to enhance human development and progress in larger communities. Increasing large group community cohesion and enhancing collaboration among people can be the remedy to some of the world problems. Since splitting, division, and polarization (following Hopper’s 4th basic assumption) became the world’s disease and dis-ease, focusing on collaboration can become an antidote to these problematic social processes.
The way that the world is eventually slowly overcoming the pandemic can be a good example for this repairing process. As long as countries were focusing on blaming other countries (“the Chinese virus” according to Trump), and ignoring their interdependence and mutual responsibility, the corona virus was spreading uncontrollably and the number of Covid cases accelerated. The moment that nations started collaborating, exchanging information about the nature of the virus and its spread – it allowed for the development of vaccination and for a decrease in the Covid morbidity (before the Delta Variant). The real antidote to epidemic is not segregation, but rather cooperation.
Yuval Noah Harari, the famous writer and historian, had pointed out before the pandemic started (January 2020 in Davos) that to do something effective, we need global cooperation, but unfortunately, just when it is more needed than ever before, some of the most powerful leaders and countries in the world are deliberately undermining global cooperation. In March 2020 he wrote that “a collective paralysis has gripped the international community. There seem to be no adults in the room. One would have expected to see already weeks ago an emergency meeting of global leaders to come up with a common plan of action”.
The global warming and climate change is another good example for the need of cooperation and collaboration. It’s clear that one country cannot effectively deal with this threat and that the future of the globe depends on a collaborative effort of all countries, rich and poor, to immediately act to stop the damage.
How can we, as group therapists, contribute to improving the world situation in times of pandemic, climate change and other social conflicts? We certainly should leave our comfortable couch and abstinent position, expand our focus in our groups from the here-and-now to the there-and-then, and include the exploration of social unconscious processes in our groups. We should also develop more effective large groups to learn about those social processes and work through splitting and social traumas that still affect our behavior. Using our knowledge in groups beyond helping people with psychological disorders and focusing on how to repair and heal the world might be a positive step forward.
[1] Some of the ideas in this presentation will appear in the introduction to Volume 4 of the series of books about the Social Unconscious that Earl Hopper and I co-edit. Other ideas are taken from my article “Die Zukunft der Gruppenpsychotherapie und Gruppenanalyse” in Gruppenpsychother. Gruppendynamik 57/2021, 41-48.