The Theory and Practice of Group Psychotherapy (21 page)

Family Reenactment

Family reenactment, or the corrective recapitulation of the primary family experience—a therapeutic factor highly valued by many therapists—is not generally considered helpful by most group members. The clinical populations that place a high value on this factor are very specific—groups for incest survivors
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and groups for sex offenders.
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For these members the early failure of the family to protect and care for them looms as a powerful issue.

The fact that this factor is not cited often by most group members, though, should not surprise us, since it operates at a different level of awareness from such explicit factors as catharsis or universality. Family reenactment becomes more a part of the general horizon against which the group is experienced. Few therapists will deny that the primary family of each group member is an omnipresent specter haunting the group therapy room. Clients’ experience in their family of origin obviously will, to a great degree, influence the nature of their interpersonal distortions, the role they assume in the group, and their attitudes toward the group leaders.

There is little doubt in my mind that the therapy group reincarnates the primary family. It acts as a time machine, flinging the client back several decades and evoking deeply etched ancient memories and feelings. In fact, this phenomenon is one of the major sources of power of the therapy group. In my last meeting with a group before departing for a year’s sabbatical, a client related the following dream: “My father was going away for a long trip. I was with a group of people. My father left us a thirtyfoot boat, but rather than giving it to me to steer, he gave it to one of my friends, and I was angry about this.” This is not the place to discuss this dream fully. Suffice it to say that the client’s father had deserted the family when the client was young and left him to be tyrannized thereafter by an older brother. The client said that this was the first time he had thought of his father in years. The events of the group—my departure, my place being taken by a new therapist, the client’s attraction to the co-therapist (a woman), his resentment toward another dominating member in the group—all acted in concert to awaken long-slumbering memories. Clients reenact early family scripts in the group and, in successful group therapy, experiment with new behavior and break free from the rigid family roles into which they had long been locked.

While I believe these are important phenomena in the therapeutic process, it is altogether a different question whether the group should focus explicitly on them. I think not, as this process is part of the internal, generally silent, homework of the group member. Major shifts in our perspective on the past occur because of the vitality of the work in the present—not through a direct summons and inquiry of the spirits of the past. There are, as I will discuss in chapter 6, many overriding reasons for the group to maintain an ahistorical focus. To focus unduly on people who are not present, on parents and siblings, on Oedipal strivings, on sibling rivalries, or patricidal desires is to avoid and deny the reality of the group and the other members as a living experience in the here-and-now.

Existential Factors

The category of existential factors was almost an afterthought. My colleagues and I first constructed the Q-sort instrument with eleven major factors. It appeared neat and precise, but something was missing. Important sentiments expressed by both clients and therapists had not been represented, so we added a factor consisting of these five items:

1. Recognizing that life is at times unfair and unjust

2. Recognizing that ultimately there is no escape from some of life’s pain or from death

3. Recognizing that no matter how close I get to other people, I must still face life alone

4. Facing the basic issues of my life and death, and thus living my life more honestly and being less caught up in trivialities

5. Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others

Several issues are represented in this cluster: responsibility, basic isolation, contingency, the capriciousness of existence, the recognition of our mortality and the ensuing consequences for the conduct of our life. What to label this category? I finally settled, with some hesitation, on
existential factors,
meaning that all these factors relate to existence—to our confrontation with the human condition—a confrontation that informs us of the harsh existential facts of life: our mortality, our freedom and responsibility for constructing our own life design, our isolation from being thrown alone into existence, and our search for life meaning despite being unfortunate enough to be thrown into a universe without intrinsic meaning.

It is clear that the existential items strike responsive chords in clients, and many cite some of the five items as having been crucially important to them. In fact, the entire category of existential factors is often ranked highly, ahead of greatly valued modes of change such as universality, altruism, recapitulation of the primary family experience, guidance, identification, and instillation of hope. Item 60,
Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others,
was ranked fifth overall of the sixty items.

The same findings are reported by other researchers.
Every single project that includes an existential category reports that subjects rank that category at least in the upper 50 percent.
In some studies, for example, with therapy groups in prison, in day hospitals, in psychiatric hospitals, and in alcohol treatment groups, the existential category is ranked among the top three factors.
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Existential factors are also central to many of the current group therapy interventions for the seriously medically ill.
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A group of older women ranked existential factors first,
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as did a sample of sixty-six patients on an alcohol unit.
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What unites these divergent clinical populations is the participants’ awareness of immutable limits in life—limits of time, power, or health. Even in groups led by therapists who do not conceptualize existential factors as relevant, the existential factors are highly valued by the group members.
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It is important to listen to our data. Obviously, the existential factors in therapy deserve far more consideration than they generally receive. It is more than happenstance that the category of existential factors was included almost as afterthought yet proved to be so important to clients. Existential factors play an important but largely unrecognized role in psychotherapy. There is no discrete school of existential psychotherapy, no single accepted body of existential theory and techniques. Nonetheless, a considerable proportion of American therapists (over 16 percent in a 1983 survey—as large a group as the psychoanalytic contingent) consider themselves to be existentially or “existentially-humanistically” oriented.
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A similar proportion of senior group therapists surveyed in 1992 endorsed the existential-humanistic approach as the model that best reflects contemporary group therapy.
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Even therapists who nominally adhere to other orientations are often surprised when they look deeply at their techniques and at their basic view of the human situation and find that they are existentially oriented.
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Many psychoanalytically oriented therapists, for example, inwardly eschew or at best ignore much of the classical analytic theory and instead consider the authentic client-therapist encounter as the mutative element of therapy.
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Keep in mind that classical psychoanalytic theory is based explicitly on a highly materialistic view of human nature. It is not possible to understand Freud fully without considering his allegiance to the Helmholtz school, an ideological school that dominated Western European medical and basic research in the latter part of the nineteenth century.
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This doctrine holds that we human beings are precisely the sum of our parts. It is deterministic, antivitalistic, and materialistic (that is, it attempts to explain the higher by the lower).

Freud never swerved from his adherence to this postulate and to its implications about human nature. Many of his more cumbersome formulations (for example, the dual-instinct theory, the theory of libidinal energy conservation and transformation) were the result of his unceasing attempts to fit human behavior to Helmholtzian rules. This approach constitutes a negative definition of the existential approach. If you feel restricted by its definition of yourself, if you feel that there’s something missing, that we are more than a sum of parts, that the doctrine omits some of the central features that make us human—such as purpose, responsibility, sentience, will, values, courage, spirit—then to that degree you have an existentialist sensibility.

I must be careful not to slip off the surface of these pages and glide into another book. This is not the place to discuss in any depth the existential frame of reference in therapy. I refer interested readers to my book,
Existential Psychotherapy
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and to my other books that portray the existential clinical approach in action,
Love’s Executioner,
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When Nietzsche Wept,
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The Gift of Therapy,
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Momma and the Meaning of Life,
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and,
The Schopenhauer Cure
.
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For now, it is sufficient to note that modern existential therapy represents an application of two merged philosophical traditions. The first is substantive:
Lebensphilosophie
(the philosophy of life, or philosophical anthropology); and the second is methodological: phenomenology, a more recent tradition, fathered by Edmund Husserl, which argues that the proper realm of the study of the human being is consciousness itself. From a phenomenological approach, understanding takes place from within; hence, we must bracket the natural world and attend instead to the inner experience that is the author of that world.

The existential therapeutic approach—with its emphasis on awareness of death, freedom, isolation, and life purpose—has been, until recently, far more acceptable to the European therapeutic community than to the American one. The European philosophic tradition, the geographic and ethnic confinement, and the greater familiarity with limits, war, death, and uncertain existence all favored the spread of the existential influence. The American zeitgeist of expansiveness, optimism, limitless horizons, and pragmatism embraced instead the scientific positivism proffered by a mechanistic Freudian metaphysics or a hyperrational, empirical behaviorism (strange bedfellows!).

During the past four decades, there has been a major development in American psychotherapy: the emergence of what has come to be known as the third force in American psychology (after Freudian psychoanalysis and Watsonian behaviorism). This force, often labeled “existential” or “humanistic,” has had an enormous influence on modern therapeutic practice.

Note, however, that we have done more than imported the European existential tradition; we have Americanized it. Thus, although the syntax of humanistic psychology is European, the accent is unmistakably New World. The European focus is on the tragic dimensions of existence, on limits, on facing and taking into oneself the anxiety of uncertainty and nonbeing. The American humanistic psychologists, on the other hand, speak less of limits and contingency than of human potentiality, less of acceptance than of awareness, less of anxiety than of peak experiences and oceanic oneness, less of life meaning than of self-realization, less of apartness and basic isolation than of I-Thou and encounter.

Of course, when a basic doctrine has a number of postulates and the accent of each is systematically altered in a specific direction, there is a significant risk of aberration from the original doctrine. To some extent this has occurred, and some humanistic psychologists have lost touch with their existential roots and espouse a monolithic goal of self-actualization with an associated set of quick actualizing techniques. This is a most unfortunate development. It is important to keep in mind that the existential approach in therapy is not a set of technical procedures but basically an attitude, a sensibility toward the facts of life inherent in the human condition.

Existential therapy is a dynamic approach based on concerns that are rooted in existence. Earlier I mentioned that a “dynamic” approach refers to a therapy that assumes that the deep structures of personality encompass forces that are in conflict with one another, and (this point is very important) these forces exist at different levels of awareness: indeed, some exist outside of conscious awareness. But what about the
content
of the internal struggle?

The existential view of the content differs greatly from the other dynamic systems. A classical analytic approach, for example, addresses the struggle between the individual’s fundamental drives (primarily sexual and aggressive) and an environment that frustrates satisfaction of those drives. Alternatively, a self psychology approach would attend to the individual’s efforts to preserve a stable sense of self as vital and worthwhile in the context of resonating or disappointing self-object relationships.