Motherhood and Group Analysis – An Exploration
In the analytic world, we often hear about the founding fathers. The professional legacies of Freud and Foulkes are important but sometimes I have the impression that the two men are significantly idealised although they left us with many unanswered questions. One could consider the questions as gifts as they make us think further. One could also ask: where are the female voices and the founding mothers?
Having been pregnant during my psychoanalytic training in 2015 and again in the course of my group analytic training in 2021, I found myself confronted with different issues Foulkes and his colleagues most probably might not have thought of. How does being pregnant and being a mother of a new-born child affect group work, transferences, counter transference, and the interplay between the three group settings of the group analytic training: therapy group, supervision group, and training group?
A quick search revealed only four articles from the 1990s in the Journal of Group Analysis which address those highly complex dynamics. I was grateful to the female authors (Anderson, 1994; Gavin, 1994; Rogers, 1994; Trampuz, 1997) since their reflections gave me guidance and made me feel connected and understood. At the same time, I was wondering why there was so little literature on the topic of the pregnant group analyst or therapist whereas there are many publications in the field of individual therapy. I suspect it is a matter of age: there is a tendency that group analysts train later in life after having kids – if they have any, of course. In Germany, the conventional pathway is studying medicine or psychology and then, finishing a post-graduate therapeutic training at a therapy institute in order to become an individual therapist. The therapeutic training takes at least 5 years, usually longer, and by the time the doctor or psychologist is a psychoanalyst for instance, he or she is way past age 30. Some individual therapists want to add the qualification as a group analyst. Thus, they start the group analytic training in their 30s or later. This sequence of qualification steps makes sense because of the German health system: with a state licence you can offer individual therapy in private practice and patients with state health insurance – 90% of the German population – get fully covered treatment. And you can only get a state licence when you are a qualified individual therapist. Furthermore, you can only offer group treatment that is paid by the patients’ insurances when you have the licence to practice individual therapy. That means, there currently is a clear hierarchy of treatments Foulkes would probably object to. But that is about to change. The German ministry of health is in the (long) process of changing the qualification system for psychological psychotherapists. The new idea is to study ‘psychotherapy science’ at university with integrated elements of the former practical training at the therapy institutes such as seeing patients under supervision. Another important aspect is that the group training will be integrated as well. Because the government and the insurance companies see group therapy as more efficient as it is less expensive, they want to promote group treatment. In the future, a group therapeutic qualification is going to be mandatory for all psychologists (and doctors as well).
Why do I write about German health policy? Because context matters. After finishing their specialisation in individual (e.g. cognitive-behavioural, psychodynamic) and group therapy, German trainees are going to be much younger than today’s graduates. Being in touch with group analytic trainees in other countries, I know for a fact that today, there are already several young group analysts to be, e.g. at the institutes in Albania, India or Serbia. One could ask what is young? Under 30, I would say. If you want to have kids, when are you supposed to have them? When the private practice is nicely set up and all trainings are finished? In your forties or fifties? That might be a different reality for men than for women, for sure.
Considering these developments, my prognosis is that more trainees will face the challenge of becoming a parent during group therapeutic training. That is especially challenging for female trainees because becoming a mother is difficult to keep a secret. The changing body is for everyone in the group(s) to see.
An interesting experience is to watch the film ‘Personal encounters with SH Foulkes’ (Brunori & Knauss, 1999) and to pay attention to what the women say. In the second part of the recorded group conversation among colleagues who have worked with Foulkes personally, Anne Ancelin Schützenberger tells an anecdote (starting minute 1.17): Foulkes had a slightly different attitude to men and women and maybe he was more contradicting women. She was giving support to Meg Sharpe who experienced Foulkes as very critical of her ideas. Anne Schützenberger was apparently an attractive woman and Foulkes once said to her, ‘Anne, you are … young, beautiful, intelligent, striking, forget it! If you want to be a group analyst and a group therapist: shadow yourself a lot!’ The group she was talking to seemed to be puzzled by her memory. She went on saying that she thought ‘it was a very, very good lesson because you cannot be a group analyst or a therapist if … people think you are outstanding. So I started dressing in black, putting glasses [on], trying to shadow and shut up a lot – for many years.’ She ended with a smile.
I would like to think about what the episode of SH Foulkes and Anne Schützenberger means for the matrix of the group analytic profession. On the one hand, it is nice to hear that a women can be both, beautiful and intelligent. On the other hand, it is obvious that Foulkes’ comment about throwing a shadow over a female colleague came from a position of being in a patriarchal and sexist culture that puts women in a subordinate role. I highly doubt he would have said to a handsome male colleague that he needs to shadow himself to work as a group analyst or therapist. Anne’s smile, her uncritically following his ‘orders’, and calling it a useful lesson can be seen as internalized misogyny. There is a moment of silence and possibly astonishment in the group but the issue of Foulkes telling a woman to cover herself is not explored any further.
Of course, the father of group analysis was acting in a matrix of his time and a lot of years have passed since Anne’s encounter with him. Nevertheless, I keep wondering whether this thinking is still prevalent in group analytic institutions of today. As I said before, there are and will be more young and potentially beautiful female trainees and they will be confronted by senior supervisors, male and female, who carry Foulkes’ legacy.
To go one step further, what would Foulkes have said to a pregnant group analytic colleague? To cover her growing belly? To stop working with groups entirely? This can be seen as wild speculation, I am aware of that, but I want to highlight the responsibility of supervisors. Besides the group analysts the trainees do their own therapy with, supervisors are the most influential persons during the group analytic training since they convene the supervision groups and directly affect the trainees’ experiences in and reflections of the training group.
Witnessing a pregnancy can trigger lots of feelings, consciously and unconsciously. In 2021, when I told my individual and group patients that I was pregnant many congratulated me and initially showed a joyful response. But there was also annoyance, anger, disappointment, sadness, fear of abandonment, and envy – just to name a few emotions that arose. That is true for patients, but also for colleagues. I believe their own history of being a child and of parenthood, fulfilled or unfulfilled, is automatically activated in the therapy or supervision group matrix, whether it is talked about or not.
I will now focus on supervision groups and tell an episode from my first supervision group session in my group analytic training in July 2019: I felt very ready to start an outpatient group after being in training for several years, having convened many groups in different hospital settings, and finally setting up my own private practice. At the same time, my husband and I wanted a second child. I was 36 at the time and not getting any younger. I openly shared my two wishes, having a group and having a baby, and the group that consisted of women only during that session was very critical. I heard, ‘you are so young, why don’t you start a group later, after having another baby?’ At first, I thought it was caring and protective, helping me not to overburden myself. But then I realised it was not very encouraging and giving me a choice: either setting up a group or having a baby. Was it impossible to have both? Was I presumptuous? I did not know when I would get pregnant again or if at all. So why wait with the next step of my career? Would I be a bad mother to my child if I had a group of patients depending on me? Would I be a bad group analyst if I had a growing belly and a baby to nurse? The concern of my fellow female trainees was not commented on by our female supervisor. She tried to remain neutral by focusing on structural issues like having a break while convening the training group. I did not feel very much supported but was convinced that in the case of a second pregnancy I would be able to find a solution.
Looking back on the reaction of my fellow trainees, I think about ageism: I was the youngest in the group but with the same goal of becoming a group analyst. It was possibly hard to bear to see me working towards a desired career step and reaching it several years earlier. But if I would do that with another baby at home, how can I dare? This dynamic, especially between women, was not reflected upon and unfortunately, the pandemic hit in March 2020 and got everyone’s attention masking potential rivalry and complicated feelings.
Through an exchange with a senior group therapist from The States, an idea of a joint webinar on the topic ‘parental leave, patient care, and parenting’ was born in the fall of 2021. Reflecting on his own experience of becoming a parent during therapeutic training and witnessing me on break in my practice and during group analytic training, he thought it was an important issue that was worth raising awareness of (AGPA Webinar, chaired by Godby & Black, 2022). Interestingly, an announcement on the GASi Forum on December 30, 2021, got only little response. I wrote, ‘a challenge during psychotherapeutic and group analytic training is getting pregnant and becoming a parent. As trainees get younger, this might happen more often in the future – the pregnant group analyst in training – and could very well be an important topic in supervision groups affecting transference/countertransference relationships.’ Even as the thread of emails got picked up and developed in many different directions, there were no thoughts about challenging dynamics in supervision groups and hardly any group analytic supervisor did attend our webinar. Of course, I do not know what is being discussed among supervisors at group analytic institutes in the UK, Europe, and beyond.
Because a pregnancy of the female conductor in training adds another layer to the complexity of the group work, I see the danger of becoming a ‘complicated supervisee’, analogue to a ‘difficult patient’ in a group. It is potentially more work for the supervisor such as organising the parental leave and thinking about different options such as a replacement therapist with all its implications. Sitting in second row, supervisors might feel very responsible for the patients in the training group when the pregnant convenor and trainee is about to leave. It could potentially happen that the supervisor unconsciously identifies with the group that is left alone causing anger, helplessness, or feelings of abandonment. The supervision group can be a useful resource and a frame of reference while navigating through that process, that is if the supervisor allows him/herself to be open to critical self-reflection and facing own blind spots and vulnerabilities.
An interesting model of supervision is proposed by Meg Sharpe and colleagues in 1987. In my opinion, it would create exactly the setting in which ‘flexible, effective and imaginative … supervision’ (Sharpe & Blackwell, 1987, p.195) could flourish. The model basically comprises setting up a ‘collective mutual assessment procedure which included putting the supervisor “on the line”. She [the supervisor] considered it important that the situation should be one of mutual learning so that she too could enjoy seeing things differently for the first time’ (p.197). It was agreed that ‘each term the [supervision] group would discuss and evaluate each other’s performance, including the supervisor’s. After this a report would be drawn up and discussed before submission to the Training Committee’ (p. 198). The fact that the supervisor saw herself in the position of a learner under peer assessment created an atmosphere on eye level reducing hierarchy and related anxieties of the trainees. It encouraged the students with trusting their perceptions and analyses and led to a playful and cohesive supervision experience. I share the view of the authors who express in the summary of their article that ‘such a model is highly congruent and consistent with the Foulkesian group-analytic model of psychotherapy’ (p. 206). I wonder if Foulkes would agree since he was very critical of Meg Sharpes’ ideas.
A pregnancy as well as starting and convening a therapy group are both adventures into the unknown. A supervisor can be seen as a ‘guide, mentor and comforter’ (Sharpe & Blackwell, 1987, p.197) on this exciting but sometimes frightening journey but also as extended family, as an ‘analytical grandparent’ of the group or as part of the village that is needed to raise a child (or a group). Providing support, openness, and flexibility in supervision groups for the exploration of one’s own group analytic identity is crucial, especially when trainees are pregnant.
At first, I wanted to write ‘innovative model of supervision’ which is a bit odd since the paper was published 35 years ago. I do wonder why this was not discussed further in group analytic institutes. Traditional authority-dependency relationships between teachers and taught, as well as issues of power, hierarchy, and leadership probably play an important role. One teacher I appreciate a lot always encourages me by saying, ‘Anyone who has taught anything at all well, whether it is psychotherapy or football, knows the importance of getting students to believe in themselves and trust their intuition. I so wish we could kill off this idea that there is a right way to do group analysis and recognise that the therapists have to free themselves and take a few risks if they are going to create a space where their patients can do the same’ (personal communication, 2021). So maybe this is a call to the group analytic supervisors out there to reflect on their training. Sharpe et al. (1987) wrote that ‘[b]ecoming a good supervisor is almost as difficult as becoming a good analyst’ (p.207). A future perspective can be to encourage ‘the students of group-analysis … to “teach” each other, and to help their teachers to learn’ (p.207).
I am writing this explorative paper while still being on parental leave, not having returned to my training group yet. The trajectory of my training group is unique and unorthodox: I convened for almost a year during the pandemic (2020/21) and then a female colleague, also a psychoanalyst and group analyst in training like me, took over. We had one group session together in May 2021 where she introduced herself to the group. This was also my last session before I went on break. She is conducting the group since June 2021 and now, we are in supervision together planning my return for May 2022. Shifts in leadership are major structural changes patients have to bear and tolerate. The pressure of being in training, of being ‘a good student and supervisee’ can come with feelings of guilt, insufficiency, and shame, not providing a ‘good enough’ environment for the group of patients. Right now, I can only say that finding my colleague was like a gift I am grateful for. I could hand her my ‘group baby’ and knew it was in good hands. She is part of the group’s ‘village’, too. It makes sense for both of us to integrate the different group experiences – the patients have witnessed me as a convenor, then her as a convenor – so we will co-convene starting soon. We both wrote a ‘group fantasy’ independent from each other, a reflection on how we both think and feel about the start of our journey as co-convenors. That was a helpful suggestion of the training committee at our institute in Berlin. We are now ready to dive in, to make mistakes, to learn from them and – hopefully – we will be able to bring our experience to the group analytic community, here in Group-Analytic Contexts or elsewhere.
References:
AGPA Webinar, chaired by Godby, D. & Black, M. (2022). 01.16.2022 – Patient Care, Parental Leave & Parenting. https://member.agpa.org/itemdetail?iproductcode=AU20220116NC
Anderson, L. (1994). The experience of being a pregnant group therapist. Group Analysis, 27, 75-85.
Brunori, L. & Knauss, W. (1999). Personal Encounters with SH Foulkes. Video in three parts to be seen on the website of the Group Analytic Society international (GASi). https://groupanalyticsociety.co.uk/video-personal-encounters-with-s-h-foulkes/
Gavin, B. (1994). Transference and countertransference in the group’s response to the therapist’s pregnancy. Group Analysis, 27, 63-74.
Rogers, C. (1994). The group and the group analyst’s pregnancy. Group Analysis, 27, 51-61.
Sharpe, M. & Blackwell, D. (1987). Creative Supervision through Student Involvement. Group Analysis, 20, 195-208.
Trampuz, D. (1997). Why are women allowed to be group analysts? Reactions to a conductor’s pregnancy. Group Analysis, 30, 245-257.