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Moving beyond Yalom: Breaking down major group theories

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vinny-malik-dehili Vinny Malik Dehili, PhD, CGP 

This article is a continuation of the Fall 2020 article on group theory in The Group Psychologist, outlined as a group theory seminar syllabus that was piloted at the University of South Florida’s Counseling Center in Summer of 2020 and published in the Fall 2020 edition of The Group Psychologist, Vol. 30, No. 3.

Attachment and Mentalization-Based Group Therapy: Holding a mind in mind

This section combines two articles of the theories listed in the 75th edition of the Journal of American Group Psychotherapy Association. Attachment theory has become more integral in understanding and conceptualizing the interpersonal patterns and innate processes that influence people’s behaviors when seeking emotional connection from others in times of needs (Bowlby, 1979; 1988).

Mentalization-Based Therapy (MBT) originally was created to reduce self-harm and suicidal behaviors in clients with borderline personality disorder but contains a myriad of transferable skills and applications to the general population (Bateman and Fonagy, 2013; Kalssen, 2017). The theory of MBT highlights the function of attachment relationships and their role in forming epistemic trust—trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment functions and how to navigate it to have your personal needs met.

Theoretical constructs core to the organization of MBT consists of pre-mentalizing modes: psychic equivalence, pretend mode, and teleological mode. In a pre-mentalizing mode, we engage with our thoughts and feelings automatically, embodying them and allowing them to influence us in automatic ways that are ineffective to our own internal goals. Kalssen (2017) posits being stuck in a pre-mentalizing mode lacks curiosity and leads to clients “suffering from excessive certainty.”

Psychic equivalence is the core belief that was thought and felt is experienced as real, true, and no other possibilities can exist. One can see how this mindset may manifest in the words of group members expressing “I’m just not a social person” or “I just don’t feel like talking today.” 

Pretend mode is when clients’ content and affect become mismatched, which many people can manifest within the group setting through smiling despite discussing traumatic or difficult emotions within the group. Teleological mode is when mental states are expressed through explicit actions instead of mental representations through words (Kalssen, 2017; Karterud & Bateman, 2012).

Gestalt Group Therapy : Making contact somewhere in the between of self and others.

In Gestalt Group Therapy (GGT), members are provided space to become aware, seen, and contact one another. This section’s modern take on GGT was largely influenced by Cole & Reese (2018), where GGT allows people to integrate the known and rejected parts of themselves and become self-regulating individuals (Cole & Reese, 2018).

Gestalt theory focuses on the present moment, how we connect, attach, and protect ourselves from others (Kepner, 1980; Perls, 1973). The word Gestalt refers to a “whole” that is more than a sum of its individual parts. Self-awareness is seen as the curative and growth promoting factor which when enhanced allows members to self-regulate their behavioral and fully actualize their potential.

Goals for GGT (Cole & Reese, 2018) could be viewed from two lenses: individual goals (e.g., integrating polarities of oneself, expanding awareness, achieving contact with oneself, defining boundaries, and providing self-support) and group goals (e.g., asking clearly for what one wants or needs, effectively managing interpersonal conflict, challenge growth while respecting needs, learning to provide support and energy to others, and not give direct advice). Key principles discussed in GGT consist of the following: holism, field theory, and the figure-formation process.

Holism is described as focusing on healing the self, the field around us, and the constructions we make between the two that impact action (Cole & Reese, 2018). Field theory posits that we in our small field or system within group are unduly influenced by the greater society field, creating a microcosm in the group of larger society. An example of this would be the manifestation of racist beliefs that villainize BIPOC as being “thugs” and “criminals,” which may lead to members feeling more emotions of fear or perceived “aggression” at a Black member’s behavior compared to that of a white peer mirroring similar behavior.

Systems-Centered Therapy: Shifting perspectives to not take things “just personally”

Systems-Centered Therapy (SCT) is a theoretically based practice developed from the foundation of the theory of living human systems (Agazarian, 1997, 2012; Gantt & Agazarian, 2017). SCT creates a unique culture to have members reflect the core understanding of the messages conveyed by other group members while intervening to challenge defense mechanisms that occur in members in a developmentally adapted manner (Gantt & Agazarian, 2017).

Functional subgrouping is the unique, core concept and intervention that will not be provided adequate justice in this short summation. In essence, human beings in groups are typically led to create two problematic group dynamics: the identified patient and the scapegoat (Agazarian, 1997, 2012). This method avoids these common pitfalls by allowing members to de-personalize the interactions that take place within the group and integrate differences more easily among members (Gantt & Agazarian, 2017).

This process consists of people in certain subgroups being asked to speak to one another around a shared belief or theme. An example may be if some members in the group feel anxious at the lack of direction compared to others who feel excited, the anxiety members may be asked to subgroup with one another and discuss their experiences of anxiety in more detail. These members will slowly begin to differentiate their perspectives and create diversity within their shared experience of “anxiety,” leading to tolerable differences within the subgroup. At some point, boundaries of the subgroup will be opened so that the members across different subgroups notice and merge similarities with one another, creating a more dynamic, safe, and complex system.

On an individual level while engaging in dialogue, members are instructed is listen to what other members say curiously. When a member finishes a statement, they will end their sentence with, “Anyone else?” This indicates that they have finished their statement and opens the dialogue up. Before other members answer with their own thoughts, the members are instructed to paraphrase what the previous member stated, looking at them for verbal and/or non-verbal cues that they have accurately attuned to the heart of their message. Only once affirmed by the other members can a member add their voice to join them in their thought or expression, ending their sentence with, “Anyone else?” This cycle repeats, allowing others to integrate differing perspectives without eliciting typical process group dynamics, such as relying on a scapegoat or identified patient as a method to illuminate growth or differentiation in process groups. (Agazarian, 1997, 2012).

Object Relations: Projecting the parts of ourselves to connect with others

Object Relations is one of the four main theoretical models within psychodynamic therapy (Frankland, 2010). It assumes that people are born seeking and needing relationships, meaning that all the actions taken by individuals are an attempt to connect with others (Buchele & Rutan, 2017). Awareness is brought to the defenses that hinder members from creating and maintaining positive interpersonal relationships in exchange for temporary safety and protecting themselves from vulnerability (Buchele & Rutan, 2017). A focus of the theory is on bringing awareness to the defenses that constrain intimacy with others and exploring the impact others have towards their methods of relating.

One of the key concepts within Object Relations is projective identification (Buchele & Rutan, 2017). Projective identification is the concept where an individual “projects” a part of themselves into another person, allowing them to disown an unsatisfying emotion or part of themselves and forcing the recipient to feel and behave as if characterized by this thought or emotion.
An example would be if a member (Peter) is told by another member (Gamora) that she feels frustrated at him diverting the conversation away from her in the middle of a story. Peter may feel embarrassed and selfish, but rather than own that part of himself, he responds, “You’ve talked for half the session. Haven’t you gotten enough from the group today?” This phrase pushes Peter’s disowned emotions of embarrassment or selfishness into Gamora, creating fear of her taking up time and leads to her lashing back out verbally, “No! This is more important for me to finish than you.” Thus, Gamora was influenced to embody the selfishness through the actions and words that Peter used to reject his own emotions.

Jungian Group Therapy: Empowerment to own our stories and unconscious

A unique and newer exploration within group theory is the contribution that Jungian psychology has on group therapy work. Hecht (2011) is used as the seminal refence point to illuminate the contributions that Jungian therapy to group therapy: (a) a broader conceptualization of libido, (b) attitudes towards the unconscious, (c) individuation, (d) ego-self axis, (e) the problem of opposites, (f) an alchemical approach to transference, and (g) archetypes and the collective unconscious.

Hecht (2011) reflects on Jung’s concept of Kinship Libido, which is a core drive for affiliation and relation to others within human existence, humanizing the desires of non-romantic connections, creativity, and attraction. This concept is embodied through members being encouraged to lean into the love or energy flow of the parts of another member’s personality. Individuation is described as one’s sense of self and the persona in which we project to meet expectations/demands of our social role in life.

The Transcendent Function arises from the union of conscious and unconscious content. (Jung, 1957). Jungian therapists engage in members holding onto dialectical paradoxes for seemingly contradictory parts of their personality or “shadow self.” Processing either-or dichotomies (e.g., love and hate experienced in long-term relationships) allows Jungians to model being comfortable with holding onto two disparate parts.

Archetypes are noted as ancient, passed-down myths of humanity that serve to guide, inform, or inspire individuals’ visions for their own life journeys (Hecht, 2011). Since narratives within our lives are not often viewed with a widened, cosmic view, Jungians seek to provide meaning-making and perspective taking to the perilous encounters and journeys that one has overcome over the years. Group members may be asked to “zoom out” to a cosmic view of a specific member’s life journey. This would allow them to generate diverse perspectives and interpretations using mythological analogies or stories to imbue purpose and meaning if a member becomes to consumed by the reality of their present turmoil (Hecht, 2011).

Psychodrama: Less talking, more doing

Psychodrama is an experiential, powerful approach to group work in which physical movement and dramatic improvisation is used to re-enact and physically enact the internal mental defenses or symptoms that individuals experience (Moreno, 1969/1975). This diversion from the traditional Interpersonal Process Therapy encourages member to act rather than talk through their internal processes.

Although psychodrama is a complete orientation and approach in and of itself, techniques and interventions within it can be adapted for outpatient process groups to the benefit of members (Nicholas, 2017; Treadwell & Dartnell, 2017, 2021). The psychodramatic protocol has three components: (1) “the warming up phase,” (preparing protagonist); (2) locating the conflicting situation and acting it out, “the action phase;” and lastly, (3) involving group members to contribute their personal responses to the protagonist, “the sharing phase.” 

A “protagonist” in psychodrama is typically selected as the focal person who engages in emotional work while other group members assist as “auxiliaries” who portray parts of the person’s internal world. The group leader is referred to as the “director” of the psychodrama. A few of the many psychodramatic techniques utilized as interventions adapted from psychodrama consist of doubling, role playing, role reversal, and role training.
Doubling is defined as another member or group leader playing the part of a protagonist’s inner self. Doubling helps people make connections with thoughts and feelings that they may not be able to express due to shyness, fear, or an inability to name their inner experiences.

For example, once the protagonist is identified, the director asks the protagonist to select a person from the group who could “step in your shoes and express thoughts and feelings you experience but are not expressing.” This is how a double is identified. As the situation continues, a protagonist may state to one’s significant other “I just don’t understand why you left me”.  The double expresses thoughts one feels the protagonist is feeling by not expressing; for example, “I’m so frustrated that you don’t seem to care about me!” This expression allows the protagonist to alter the statement or reject it entirely, allowing for further exploration or expansion to the internal experiences of the protagonist (Nicholas, 2009; 2017).

Psychodrama is a systematized method of role-playing enabling an individual, within a group setting, to explore the psycho-social dimensions of conflicts, problems, interpersonal relationships, and life situations through enactment rather than solely verbal means. By physically re-enacting experiences, the past is brought into the here-and-now, permitting one to process memories with the therapist’s/director’s guidance along with the participation of group members with similar traumas (Kipper, 1998).

Transactional Analysis and Re-decision Therapy: Being okay with your inner child

Transactional Analysis (TA) and Re-decision Therapy (RT) are two separate, complimentary theories. RT is a succinct, intensive, psychodynamic, action-oriented process originally developed by Robert and Mary Goulding (Goulding & Goulding, 1979; Joines, 2004). TA was developed by Eric Bern as a theory of personality, human interaction, and psychotherapy (Solomon, 2003).

The combination of these theories creates a unique fusion of psychodynamic and gestalt theory principles, producing a group experience that focuses on individual work in the presence of others. This gives group member universal language to recognize their (critical and nurturing) parent, provide compassion to their (adapted and natural) child, and maintain a balanced adult ego states, challenging the narratives of past scripts they wrote in childhood and work towards “being okay with who we are, completely.”

In addition to the ego states listed above, a few core concepts in TA are life positions, life scripts, and contamination. Life position refers to the predicted conclusions about oneself, others, and their world. These scripts are largely based on the outcomes of how individuals interacted with early caretakers. Paralleling attachment styles, Berne (1966; 1972) indicates this life position gives a sense of how the individual views their status in the world (e.g., I’m okay—You’re okay; I’m okay—You’re not okay; I’m not okay—You’re okay; I’m not okay—You’re not okay). This leads to people making unconscious decisions that mirror the decisions made given their childhood life position. A life script is an unconscious act which serves to allow an individual to get the unconditional love, attention, or care they desire from others.

A member who describes themselves as “just not an emotional person” may have created a script of “I am only okay if I don’t express emotions.” This script is traced back to its origin in the past, where the client is encouraged to narrate an early memory in the first-person of this behavior. This allows the individual and group to become aware of the need that this unconscious choice filled in the past while allowing the client to consciously re-decide how they can change the narrative that their scripts have led them to continuously reenact in the present (e.g., It’s okay to be vulnerable and take care of my own needs” (Joines, 2004)).

Modern Analytic: Once more, with feeling

Modern Analytic group therapy asks of members to become more aware of their own defenses through the identification of thoughts and feelings in the present moment. This bolsters an individual members resilience against avoided emotional experiences, increasing self-awareness, challenging internal narratives, and working through resistance to engaging in expressions anger and intimacy with others (Levine, 2017).

Modern Analytic prioritizes emotions above all else, indicating that the emotional resonance creates more powerful insights and connections among group members. More attention is paid to the emotions underneath an act rather than the act itself, focusing on creating a group dynamic that can intervene to individual member concerns as a way of harnessing power that is far outside the capabilities of one leader (Ormont, 1992).  The sequence of events in a group centers largely on a strong foundation of a group contract. The following are some examples of what could be contained in a modern analytic contract:

Given that there are a possibly 10 members sharing 90-minutes of talking time, this would leave everyone with approximately nine minutes each to speak. The group leader sets these expectations knowing fully that members will deviate from the contract. Which leads into the process of the group:

This theory then focuses on the multiple methods in which group leaders can intervene on resistances that occur within the members, diligently focusing on how to bridge members on the sidelines into the verbal interplay (Ormont, 2001). Bridging is a cornerstone tool to use within the modern analytic format, with a focus on drawing in group members who may have shared resistances or relate to one another.

For example, if a member, Meara, is asked a question about another member’s experience (e.g., “Meara, what do you imagine Graham is feeling right now?”), we simultaneously ease the burden of Graham being alone in the spotlight of group, engage Meara in the group dialogue, and learn about Meara’s internal world when she fantasizes about Graham’s emotional experience. After all, we are the only frame of reference for another’s world. This process demonstrates how bridging provides a multitude of benefits that could not be achieved by the group leader asking Graham directly how he feels in this moment.

Tavistock: Reflecting on the roles taken and given by our groups

Tavistock group therapy is not actually solely utilized in group therapy practice today, but it is used in organizational systems with a strong following outside of the United States. The origin and teachings of Tavistock are owed a great debt in the ways that it expanded greatly our knowledge and insight on the unconscious psychodynamic patterns of groups and roles that people take up, as well as highlighting group-as-a-whole dynamics (Bion, 1961; Ezriel, 1950).

Focus is on here-and-now interpretations only, making group-as-a-whole commentary rather than speaking to members directly. Focus is also on the unconscious patterns of the group (often making people perceive the leader as aloof or disconnected from the group experience).  Tavistock group therapy also focuses on three tiers of interpretation: (1) What is the group talking about? (required relationship); (2) What enables them to avoid the expression of something else-anger, dependency, helplessness (the avoided relationship); and (3) What do they fear might happen if they engage in the avoided expression? (the calamitous relationship).

In Tavistock, the group leader will only focus on here-and-now interpretations, make group-as-a-whole commentary rather than ever speaking directly to members, and commenting on possible unconscious patterns of the group. This leads to an intensely emotional and challenging group experience. Group-as-a-whole interventions are interventions where the group is the object of inquiry and seen as having a life apart from the members. A group member’s behavior within the group may reflect on the wish of the group itself. When group members take on roles (e.g., caretaker, silent member, scapegoat), Tavistock theory would become curious at the way in which the group may have been manipulated or pressured into a needed role through role-suction. Basic Group Assumptions are phases of the group that can be shown as resistance to engaging in the work of the group process.

Some of the Basic Group Assumptions in Tavistock are as follows:

Lacanian: Last dance with desire, language, and jouissance

Lacanian theory was a psychoanalytic theory developed by Jaques Lacan, (1966) who argued that the language and discourse with the “Other” is a representation of the unconscious (Giraldo, 2017). “Other” in this instance refers to the focus of the theory center’s around what object early in life that we “lost.” This lost object becomes the reference point to our desires and drives.

There is a strong emphasis on language in Lacanian. The dialogue in the group highlights what Lacan would call the “Imaginary.”  This concept in Lacanian theory is that the communication from one person to another is constantly distorted by a member’s unconscious experiences (Giraldo; 2012; 2017). This could be viewed simply as repeating a phrase that a member says with a curious tone or emphasis. This offers the group-as-a-whole a space to view, reflect, and reconsider the implications that this phrase has towards the group member’s internal experience.

The Symbolic in Lacanian theory is described as the set of symbols (e.g., language) in which we are “imprisoned” as speaking beings, highlighting the constrained way in which we construct, connect, and make sense of the world around us (Giraldo; 2012; 2017). Jouissance is a poignant experience which is a mixture of tension, pain, and pleasure that is persistently sought by individuals due to the lack of, or desire of, the Other (Giraldo, 2012; 2017).

Summary

This program, to my knowledge, was the first of its kind within a university counseling center internship program, and I have learned a lot through piloting this first iteration (most notably, cite your sources as you go along in creating materials). It goes without saying that these broad stroke summaries provide only the metaphorical tip of each theory’s iceberg of knowledge, concepts, and interventions. My hope is not to see this outline as the paragon of group training but a healthy first step in peaking theoretical curiosity and towards creating programs that deepen our current and future group leaders into the breadth and diversity of what group therapy can be. Creativity, diversity of perspectives, and permutations of existing theoretical orientations only serve to enhance and make our field stronger.

Thanks to the hard work of countless researchers, clinicians, and group leaders, we can now proudly declare Group Therapy is a specialty in the field of psychology. Let us all start creating training programs that do justice to that status.

Special thanks

Special thanks to the countless American Group Psychotherapy Association (AGPA) members on the Listserv who provided resources, readings, and consultations. Special thanks to the guest facilitators for the following seminars: Susan Gantt, PhD, ABPP, CGP, DFAGPA (Systems-Centered Group Therapy); Callie Nettles, LMHC (Psychodrama); Jessica D’Andrea PsyD, CTA-P, PFT, TRET (Transactional Analysis and Redecision Therapy); & Misha Bogomaz, Psy.D., C.G.P., ABPP, FAGPA (Tavistock).

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