Abstract
The importance and significance of Beyond the Anti-Group is in its challenge to the group-analytic community to think outside the box, take account of our rapidly changing social, cultural and ecological context, and develop and adapt group analytic theory and practice accordingly. Nitsun writes in a clear, articulate, fluent style, and is always a pleasure to read. He combines an extensive coverage of relevant literature and depth of analysis with clinical vignettes and personal accounts that greatly enrich and support the ideas put forward.
In this latest book he elaborates his views of destructive processes and their survival and transformation within, towards and between groups in a way that does indeed take us beyond the anti-group. Nearly 20 years on from the publication of The Anti-Group (1996), his views have been deepened and enriched by his continuing and extensive experience, primarily as clinician, but also as manager, group consultant and artist, in different contexts, in different roles and with different populations. An example of such developments is his comparison of his experience providing group-analytic therapy in the NHS and, more recently in private practice, with his growing awareness of the extent to which the personality resources and motivation of group members may facilitate or undermine the therapeutic potential of a group.
Thus his early attempts to balance what he saw as Foulkes’s rather idealised, optimistic view of group-analytic therapy groups, with a focus on destructive processes, anxieties and hostile attacks, has shifted towards a more optimistic view. Such processes, in dialectical relationship to the desire for connection and love bonds, are seen as potential catalysts for creative transformation. This optimism is particularly evident in the chapter on “falling in love” and love relationships. Here he refers to his experiences conducting groups in the private sector which have led him to consider the superior potential of group therapy (in contrast to individual therapy), to transform early relational disruptions and blockages in intimate relating.
Anxieties about annihilation and the notion of survival of such attacks takes centre stage in this book. Quoting Winnicott’s “use of an object”, he emphasises the importance of the containment, metabolising and processing of hostile attacks and the consequent creative potential for transformation. As a clinical practitioner of the same generation as Nitsun, I feel very attuned to the idea that a real understanding of the transformative potential of translating hostile and anxious attacks into direct communications takes many years of experience: namely to trust this process, and to judge when the consequence of more directly expressed hostilities and conflict can potentially be constructive and creative, rather than destructive.
This book is a personal account of his thinking, based on ideas first expressed in various lectures and talks and further developed and integrated in the writing of the book. In true group-analytic style he looks, from different perspectives, at the challenges to therapeutic practice and theory in a rapidly and dramatically changing world, a world of accelerating technological, environmental and social change.
In Part I, Nitsun considers the social impact of technology, climate change, the collapse of time, the loss of society, notions of immortality and crises of authority. In a fascinating chapter he draws on literature from a wide range of discourses, and brings together numerous relevant perspectives on accelerated and exponential change in a creative and interesting way. This then links to the need to look again at group-analytic theory and practice, at how our increasingly globalised society and expanding internet networks require an expanded version of the matrix, together with a reconsideration of the impact of changing communication patterns. He raises questions about the implications for analytic psychotherapy of the dominance of “present time” at the expense of past and future, and challenges us to consider our role in safeguarding human communication in its non-technological form. In the second chapter, using the current state of the NHS as an example, he makes a strong and convincing case for the destructive effects of repeated restructuring and rapid change in the NHS.
Part II has as its focus the clinical setting and includes chapters on the status of group psychotherapy in the public sector. Here Nitsun considers the ambivalent attitudes towards group psychotherapy and its ambiguous status in the NHS, where group-based approaches such as mentalization-based therapy (MBT), mindfulness-based cognitive therapy (MBCT) and dialectical behaviour therapy (DBT) utilize groups but do not take into account group process or the intrinsic potential therapeutic value of the group itself.
Keeping a focus on clinical setting, Nitsun questions the clinical implications of the recent increasing emphasis in group analysis on the social and the social unconscious, suggests that in his view, it compromises the notion of individuality. Claiming full commitment to the importance of social context in group analysis and acknowledging the probable controversial nature of his views, he suggests that the current emphasis on the social marginalises individual subjectivities. Here I found myself at odds with his views and interpretations of Foulkes’s writing. He seems to imply that the social perspective excludes or diminishes the notion of an individual’s inner world, rather than shapes it, that the individual is decentred by the current dominance of the social, rather than that the individual and the social/group are co-constructed and represent different perspectives in a constant dialectic. Group-analytic therapeutic method aims to treat the individual (not the group) using the medium of the group. Although he quotes Foulkes on this, it is nevertheless obscured in Nitsun’s writing. On the other hand, his call for a formulation of a developmental theory, a theory of individual development based on a group analytic perspective, in my view identifies a significant gap in group-analytic theory and will hopefully stimulate theoretical development along these lines.
In the chapter comparing group analysis and CBT groups (likely to stir strong feelings in group analysts!), Nitsun challenges the stereotypes held by many (group) analysts, of contemporary CBT theory and practice. He describes aspects of modern-day CBT approaches with its emphasis on notions of “collaborative empiricism”, socratic dialogue, meaning-making and controlled experimentation informing its model for therapeutic engagement, as having some similarities with group analysis. He also specifically details similarities and differences between a group-analytic and a group CBT approach - in this regard he suggests that group analysts have much to offer group CBT practitioners (aiming to enhance their practice and maximise the therapeutic potential of group work) by transmitting their understanding of group process and dynamics. As a clinician with many years of experience supervising and managing both CBT and group-analytic practitioners, Nitsun is in a strong position to challenge stereotypes and to provide a comparative view of these modalities. He suggests that the promotion of CBT by IAPT (initially to the exclusion of most analytic approaches) and other such political forces, has contributed to the tendency towards a polarised, oppositional stance amongst group analysts in relation to CBT.
He points to the inevitability and need for short/medium -term therapies in an NHS that is underfunded and increasingly in demand, and to the clear advantage that a modality with a strong “evidence-base” has in terms of NICE recommendations and guidelines. He also implies that the fast-moving diversification of CBT approaches to include for example, schema therapy and mindfulness might further erode the clarity of the distinction between CBT and analytic approaches.
I welcome this chapter as a challenge to stereotyped thinking. I did however find myself missing a more sceptical approach to the politics of research (the common practice of adapting one’s method and statistical strategies to get the results one is looking for) and research-based evidence, and to the short-term, fix-it attitudes that currently prevails in the NHS.
The challenges of providing a group analytic psychotherapy service in inner London with its changing population is the final chapter in this section. Here Nitsun makes a convincing case for “the group as refuge” for a contemporary urban mental health population. The picture presented, with its fluent interweaving of narrative and clinical illustration will, I think, resonate strongly with the experience of current practitioners.
Part III addresses the developmental journey of the group therapist, looking at the influence of personal, historical factors predisposing us to the chosen field of group therapy and how this and life development factors influence our practice and our style of group leadership and conducting. The profound influence of the person of the group conductor on the shape and workings of the therapy group is familiar to group analysts. Although acknowledging that these issues are commonly addressed in group-analytic supervision and training, Nitsun attempts to fill what he sees as a gap in the literature on this topic. The inclusion of autobiographical sketches from different stages of his own development to illustrate his ideas is both effective and moving.
In the final section, Nitsun enters the relatively uncharted territory of group analysis and the creative arts. Although there is a substantial body of writing on psychoanalysis and the arts dating back to Freud, it is only in recent years that group analysis has extended its reach to link to cultural products and forms of expression. Nitsun explores the convergence between group analysis and performance art and in a further chapter he analyses themes of authority and rebellion in four iconic movies: Rebel Without a Cause, If, One Flew Over the Cuckoo’s Nest and White Ribbon. Here again Nitsun challenges us to extend our thinking beyond the consulting room and into wider society.
To conclude: this book represents a distillation and a maturing of Nitsun’s thinking. Always the challenger, ready to court controversy, he has nevertheless written a well-researched, original and creative treatise on group analysis and its potential in the 21st century. It challenges us to develop and adapt to contemporary society, one in rapid flux and subject to accelerated and unpredictable change. I warmly recommend this book to those interested in the future of group analysis.