Fifty Years of AGPA 1942-1992: An Overview
SAUL SCHEIDLINGER, PH.D.
Albert Einstein College of Medicine, Bronx, NY
GERALD SCHAMESS, M.S.S.
Smith College of Social Work, Northampton, MA
A history of the first 50 years of the American Group Psychotherapy Association must be seen in the light of the growth of group psychotherapy as well as the social context in which this occurred. In his 25-year history of our Association, Pattison (1970) concluded that "The story of the AGPA is not the story of group psychotherapy, but each has been a large part of the other" (p. 21). Given the perspectives of an additional 25 years, we would add that the AGPA has also been a part of a broader post-World War II world as reflected in the human services in general and those in mental health in particular.
The Beginnings (1942-1952)
The logo with its emblazoned year 1942 notwithstanding, available evidence suggests that the first two meetings preceding the AGPA's founding actually occurred in 1943. These were held in conjunction with two sessions on group therapy, featured at the annual meeting of the American Orthopsychiatric Association in February of 1943 in New York. This Special Section on Group Therapy was chaired by Dr. Lawson G. Lowrey, the then Editor of the American Journal of Orthopsychiatry. Mr. Samuel R. Slavsori, Dr. Nathan W. Ackerman, Dr. Harris B. Peck, and two clinical social workers, Helen Glauber and Dorothy Spiker, participated. In his Introduction to the Section, Lowrey (1943) referred to his Jewish Board of Guardians' study of over 100 children treated by activity group therapy stating "...it is obvious that here is a technique which is as effective as individual therapy" (p. 650)."
Following these sessions, S.R. Slavson convened an informal luncheon of people interested in this new modality. At a follow-up meeting held at New York's Jewish Board of Guardians where Slavson worked, he was asked to head a Steering Committee of five, charged to draft a provisional constitution for the 'new organization. As described below, the composition of that Steering Committee foreshadowed the ideological differences that would soon shake the foundations of the young organization. Four of the members were psychiatrists, among them Nathan Ackerman, the subsequent founder of family therapy and Harris Peck, a future Editor of the International Journal of Group Psychotherapy. Only one, Saul Bernstein, was a social group worker.
At the next meeting in November of the same year, also held at Slavson's office, about one-half of the 20 participants were from the Jewish Board of Guardians. The enacted constitution delineated the mission of the then-named American Group Therapy Association, it became the American Group Psychotherapy Association in 195?, as being designed to "...promote interest in group therapy and coordinate and clarify the efforts of those involved in its practice and theory" (Durkin et al., 1971, p. 412). Membership was restricted to psychiatrists, psychologists, and psychiatric case workers who had at least three years of postgraduate supervised practice in psychotherapy. Persons without these educational credentials had to have five years of psychotherapy experience "...under approved supervision with psychiatrists participating" (Pattison, 1968, pp. 10-11). Slavson was elected the first President of AGPA, but the subsequent 12 Presidents were all psychiatrists. This stress on psychiatric dominance is significant and reflects, in our view, Slavson's desire to associate this new interdisciplinary organization with what he perceived as the prestige of psychiatry. In this connection, a special invitation to join the AGPA was sent to all members of the American Psychiatric Association. History must be repeating itself; AGPA today is once more seeking to attract more psychiatrists to the Association.
Slavson's insistence that AGPA membership be restricted to clinicians trained in psychotherapy precipitated a number of organizational conflicts during the 1945 and 1946 annual meetings. These culminated in the precipitous 1947 resignation of Dr. Temple Burling, a psychiatrist and AGPA President who believed that all people working with groups should be included. In his hastily drawn resignation note he said: "It is the group dynamics that does the therapy- not the skilled use of psychotherapy" (Durkin, 1949). This issue, which he perceived as a dichotomy of group dynamics versus group psychotherapy was to haunt Slavson throughout his career and will be discussed later.
When the AGPA was founded, America was embroiled in an all-out global war and its economy had been converted to a war basis. At the 1942 annual meeting of the American Orthopsychiatric Association, "...the ominous shadow of a world in a struggle to avoid an all-embracing eclipse hung more heavily... than was anticipated" (American Journal of Orthopsychiatry, 1942, p. 175). That meeting carried many programs devoted to the war effort.
The contributions of group therapy to military psychiatry were also referred to at meetings of the AGPA, particularly the fact that many of the group field's leaders (and later AGPA members) were experimenting with group methods while in the armed forces. Among these leaders were S. H. Foulkes and W. R. Bion in England as well as Samuel Hadden, Alexander Wolf, Irving Berger, and Donald Shaskan in the United States (Berger, 1978; Shaskan, 1978). It is noteworthy here that W. C. Menninger, America's chief of Military Psychiatry, considered the use of group therapy during the war as one of the three major contributions to civilian psychiatry (Menninger, 1946). Following the war's end, the AGPA approached the American Red Cross offering its services in helping veterans to obtain group therapy.
The AGPA's beginnings were unquestionably the product of Slavson's untiring and zealous efforts. He was aided at first by a few loyal associates at the Jewish Board of Guardians, among them George Holland, the organization's first Secretary-Treasurer, Charles G. McCormick, Mortimer Schiffer, and later Hyman Spotnitz. After his term as President, Slavson continued in 1944 as chairman of the influential Administrative Committee for 10 years and edited a Bulletin until the founding of the International Journal of Group Psychotherapy in 1951. He continued as its de facto Editor until 1961. Furthermore, Slavson's Jewish Board of Guardians office served as the Association's headquarters until his retirement in 1955. The move to new offices enabled the first step toward the founder's relinquishing some of his earlier control of the organization.
Slavson never disguised his strong preference for a group therapy rooted in Freudian psychoanalysis. This held true for his children's activity therapy begun in 1934 as well as for activity-interview groups initiated by Betty Gabriel In 1937, and for therapy groups designed for adults. For more than two decades, his strict guardianship of the Association's psychiatric-psychoanalytic identity served to isolate AGPA from alternative group treatment models.
Years of Expansion and Conflict (1952-1962)
In 1952, the organization was incorporated under the laws of the State of New York and its name changed to the American Group Psychotherapy Association. This followed the initial publication of the International Journal of Group Psychotherapy in April 1951 under the editorship of Lewis Loeser. In the Journal's first issue, the AGPA was described as an interest group comprising"... professional persons in a cooperative effort to study, Interpret and encourage sound practices and training in the field of group psychotherapy. Its membership comprises practitioners in the fields of psychiatry, psychiatric casework and clinical psychology." The quest to become a competency organization was to emerge later.
Meanwhile, the AGPA had grown by 1952 to 318 members from a mere 60 members in 1944. The Journal began with 300 paid subscribers. In his continuing effort to attract more psychiatrists to the organization, Slavson persuaded the Board of Directors in 1953 to make psychiatrists eligible for membership without the requirement for supervised experience expected of psychologists and of social workers (Durkin; 1949).
The years following AGPA's move in 1955 to new headquarters, with a paid Executive Secretary, were marked by much internal dissent. The conflicts arose as younger more autonomy-minded new Presidents refused to follow Slavson's dictates. Personality and ideological clashes pervaded the Board meetings; democratic procedures were frequently violated. Durkin (1949) observed: "As the younger members began to become of age and aspire to leadership, they espoused some new views, and rebelled against the conservatism and control of the founders" (p. 7).
Despite Slavson's initial qualms lest standards be, compromised, a separate training institute, attended by 200 registrants, was added to the 1957 annual conference under the direction of Milton Berger and Maurice Linden. Over the years, these institutes have grown in quality, diversity, and, especially, prestige. Experienced professionals began to compete so vigorously for the small number of voluntary instructor positions that these assignments had to be apportioned (Christ, 1977). At present, the institute has come to be generally considered as the high point of the annual conferences.
Another source of conflict during the late 1950s pertained to the quest of the local affiliate and regional societies for greater autonomy and power. In 1956, the newly formed Affiliate Local and Regional Society Committee recognized the Delaware Valley, Eastern, Louisiana, New Jersey, and Tristate Societies and by January of 1959 those in Maine, Northern California, and the South-West. In a special memorandum addressed to the AGPA Board of Directors, Slavson (1959) called for increased scrutiny of the activities of these societies, including an examination of their constitutions so as to assure their conformity with the national By-Laws. This memorandum also called for an evaluation of the institutes, which Slavson still distrusted. Slavson's influence, though diminished, was still formidable. The Board voted him ''. . . life membership . . . with full powers and privileges, including voting" (Durkin, 1949, p. 21).
With AGPA's increasingly popular publications and training endeavors came the wish to extend this recognition to the international sphere. Slavson had already lectured in a number of foreign countries and maintained an active correspondence with professionals abroad. Not to be outdone by J. L. Moreno's far flung international activities, Slavson had already named the AGPA's national organ, the International Journal of Group Psychotherapy. He and Wilfred Hulse arranged in 1953 to have the Association join the World Federation of Mental Health. A planned International Conference of Group Psychotherapy in conjunction with the World Mental Health Congress in Toronto in 1954 failed to materialize because of irreconcilable differences between Slavson and Moreno. In 1954, AGPA established a new Committee on the International Aspects of Group Psychotherapy which served as a liaison with the growing number of foreign affiliate societies. The Journal also began to carry news items about group therapy abroad including special reports from France (Lebovici, 1958) and Holland (Spanjaard, 1958).
The 1952-1962 decade of AGPA's "growing pains" coincided with the years of Eisenhower's presidency (1953-1961) also fraught with many conflicts: the Korean War, the McCarthy hearings, desegregation struggles, and political scandals. The 1950's have also been termed the years of conformity, with America categorized as "a case of the bland leading the bland." It was the land of The Lonely Crowd (Riesman et al., 1953), The Man in the Grey Flannel Suit (Wilson, 1955), and of The Organization Man (Whyte, 1956).
During that same period the mental health field was beset by unprecedented squabbles between competing schools of thought and claims for hegemony which held true for group therapy as well. In the words of Newell (1951), "By defending hypotheses with a dogmatic, almost religious zeal, by resisting demonstration and investigation, and by clothing our thoughts in jargon, we retard the progress of science and knowledge in our field" (p. 449). Within the AGPA these ideological struggles revolved around two basic camps: (1) adherents of the orthodox Freudian position championed by Slavson, and (2) practitioners of neo-Freudian, Existentialist, and Transactional Analysis, some of whom managed to attain positions as officers of the association. Such questions as whether the group therapist should disclose anything about his/her own feelings to the group, or whether one should ever couch a patient physically caused vituperative debates.
The Years of New Visions and of Maturation (1962-1972)
This decade encompassed the Kennedy years of new hope too soon overshadowed by the dark experiences of Vietnam and Watergate. In the early 1960's the Kennedy brothers managed, not unlike F.D.R., to capture the attention of America's young, reflecting an image of courage and of concern for the poor and for Blacks. The New Frontier and Great Society legislation which included Medicare and Medicaid, as well as the Community Mental Health Center Act of 1963, had profound influences on the human services.
The new Comprehensive Community Mental Health Center model was so boldly innovative in theory, practice, and scope that it was at times connoted as a "Third Mental Health Revolution," purporting to supplant the one initiated by Freud. This program called for hundreds of federally funded community-based mental health services all over America to meet the needs of all citizens, young and old. Not unlike the public health model, emphasis was divided among prevention, treatment of pathology, and maintenance of positive mental health.
The profound effect of these developments on the group field in general and on the AGPA in particular is evident when one realizes that most of the Community Mental Health Center's services had to rely heavily on group therapy and on allied group techniques. The accumulated knowledge and experience of group therapists in outpatient, day hospital, inpatient, and even preventive contexts was now in great demand. In the absence of the urgently needed cadres of skilled group practitioners, harassed administrators began to resort to rash and risky solutions, among them the assignment of individual therapists and auxiliary professionals to work with groups. Moreover, an earlier trend to employ paraprofessionals in the mental health services was extended as well to the group field.
As might be expected, these rapid developments in a sphere already beset by professional role conflicts and confusing terminology refueled the fiery issues of boundaries, of methodologies, and of differential treatment goals. Many workers began to demand that the traditional aims of uncovering unconscious conflicts and of character reconstruction be replaced with less ambitious expectations focused on enhanced ego functioning, social competence, and symptom removal. The AGPA's annual conferences and the Journal reflected this marked ferment. But the agenda of the conferences, especially, broadened to provide additional training opportunities for beginning group practitioners. The training programs of the affiliate societies responded in tandem.
During this period, clinical group therapy practice issues were also consolidated. For example, combined therapy (Aronson, 1964) was delineated with considerable clarity as were group approaches geared to the "hard-to-reach," namely, substance abusers, delinquents, and the chronically ill. Modified ways in which group modalities could be employed with socially disadvantaged minorities who populated urban ghettos were also included (Peck.& Scheidlinger, 1968).
Efforts to solidify theories of group therapy continued during the 1960's. Slavson's Textbook in Analytic Group Psychotherapy (1964) distilled 50 years of his work. Other significant works also appeared, e.g., by Wolf and Schwartz (1962) and by Foulkes (1964). Interestingly, the first two volumes, though espousing differing technical ways of treatment, share an underlying belief in the primacy of the individual-focused approach in group therapy. Foulkes, in contrast, espoused a more group-centered position reflecting an earlier assertion of his: "Take care of the group and the individual will take care of himself." Beyond this issue there lay more complex questions under dispute such as, "Are there group dynamics in therapy groups?" Or even, "Are group dynamic manifestations anti-therapeutic?" The more extreme positions of such British "Object Relations" practitioners as Ezriel (1950) and Bion (1959), who asserted that the group therapist's task resides essentially in confronting the group-as-a-whole with its shared unconscious fantasy themes, evoked much controversy among some American group therapists.
Given the relative newness of group psychotherapy and the complexity of the task of theory-building, some theoreticians, among them Arsenian, Semrad, and Shapiro (1962), Durkin (1964), and Scheidlinger (1968), considered any broad generalizations or fixed dichotomies as premature. While allowing for the presence of certain generic elements characteristic of all psychotherapy, they advocated instead a continued objective scrutiny of how these cardinal factors appear in the therapy group with its multipersonal character and group dynamic processes.
Under the 1968 leadership of its new President, Clifford Sager, a family and community psychiatrist, AGPA became more energetic in altering its earlier exclusionary stance moving to an active interchange with the broader human services in the community, By this time the organization had experienced a further impressive expansion in numbers and in prestige. With a membership of about 2000 people and annual meeting attendance of about 1000 registrants, it became a force to be reckoned with, inviting the increased interest of many allied professionals.
'These conferences, formerly held in New York City only, were now rotating among a number of U.S, cities with the large affiliate societies serving as hosts.
In 1970, Emanuel Hallowitz, a social worker, became AGPA's first nonmedical President since Slavson. His election served to reinforce the interdisciplinary character of the organization. An expert in organizational dynamics, he also became the permanent architect of AGPA's modernized By-Laws. He had earlier served as a peacemaker in the factional disputes during the 1960's.
As they acquired strength and influence, the presidents of the local societies were encouraged in the early 1960's to participate in the meetings of the Board of Directors "with voice but no vote." Their power was enhanced further via the creation of an Affiliate Societies' Committee which met annually with the national Association's President. After many heated debates, the Board of Directors decreed in 1963 that only people with qualifications for national AGPA membership could be members of local societies. This move served to assure the protection of quality requirements for membership, and led to AGPA's defining itself officially in 1968 as a competency organization.
While there had been a token Research Committee since its founding, it was not until the 1960's that truly sophisticated research, including statistical designs, became a part of the Committee's concerns (Dies, 1979). In addition, the annual institute inaugurated a Research Section whose findings appeared in the pages of the Journal.
Unlike the meetings of other professional organizations in mental health, AGPA's conferences escaped the open expression of youth revolts spawned by the Vietnam War and the sense of alienation and helplessness following the assassinations of Martin Luther King, Jr. and of Robert Kennedy. In this connection, even the 1969 annual meeting of the American Orthopsychiatric Association, which was known for its liberal stance on social issues, suffered disruption by a group of radical young mental health professionals.
The so-called Encounter Group Movement which attracted much public and media attention, even producing a best seller by one of the movement's proponents (Schutz, 1967), both challenged and embarrassed the AGPA because many people began to equate these controversial group enterprises with group therapy. That they did so was not surprising since a senior psychologist and clinician, Carl Rogers, had gone so far as to claim that the intensive encounter group was "... perhaps the most significant social invention of this century" (1968, p. 268). It is to AGPA's credit that it approached this sensitive issue in an open and responsible fashion. Relevant symposia at its annual conferences and its publications began to place encounter groups in proper perspective within the human services, stressing their being affective-educational endeavors designed for the general public, and not for the treatment of the sick. Furthermore, in a seminal paper by Parloff (1970), group therapists were asked to warn against ". . . the dangers of indiscriminate application of these procedures by undisciplined leaders to the psychologically unstable" (p. 301). Soon, other professional organizations spoke out as well, enjoining the sponsors of encounter groups to apply a series of safeguards in their operations, including the screening of participants, the employment of informed consent, and, above all, the use of trained leaders.
Elitism, Differentiation, and Competency (1972-1982)
With the morale of the country weakened by the Vietnam War and by Nixon's resignation, there ensued in the United States an era of self-questioning aggravated by President Carter's uncertain leadership and a distraught economy. The quickening pace of technological and of societal change spawned the Women's Movement in the early 1970s, together with a dawning ecological crisis. Social and moral confusion, frustration, fear, and violence all made Ronald Reagan's presidential victory a virtual certainty.
Within the AGPA, the Encounter Group Movement and the multiplicity of groups operating under trained and untrained leadership in the many Community Mental Health Centers (763 in 1982) made urgent the need for some kind of differentiation among "people helping groups" and for the careful surveillance and training of group practitioners. What soon emerged was a general consensus that clinical psychotherapy groups with their primary focus on the "repair" of personality pathology differed from "therapeutic" group modalities in mental health, as well as from the varied personal growth, training, and support-self-help groups in the community (Scheidlinger, 1982). As for training, a suggested Guidelines for the Training of Group Psychotherapists was developed in 1970, seeking to standardize the mushrooming training programs sponsored by the affiliate societies. A few years later, the Board of Directors decided in principle that AGPA accreditation be made available to all group therapy training institutions. In addition, the 1974 annual conference was the first interdisciplinary program approved to offer Continuing Education credits for physicians, a procedure which has by now been standardized at our conferences for other professions as well.
Echoing the call from the universal Women's Movement, a "grass roots" group of AGPA women members demanded the creation of a Women's Issues Task Force to foster a greater recognition of women's contributions to the organization and to facilitate their obtaining more influential roles in governance. While Henriette Glatzer had been elected the first woman President of AGPA in 1976, her contributions to the organization and to group therapy had long since received deserved recognition. More than the appreciation of one woman's worth was needed and demanded. Alonso and Rutan's article, "Women in Group Therapy" (1979), stood as part of this new Zeitgeist which also served to enhance a tangible increase in "power roles" for women in both the educational and "political" areas of the AGPA.
An "Umbrella" Organization in Pursuit of Excellence (1982-1992)
Despite the economic reverses in the United States during the late 1970s, which resulted in a substantial loss of paid AGPA memberships, the organization had by now become an effective functioning body with a sophisticated internal structure, newly purchased headquarters, and skilled administrative leadership. At a time when some other professional mental health organizations floundered in the weakened national economy and diminished funding for the human services, AGPA's cadre of dedicated leaders managed to maintain a flexible stance, prepared to adapt imaginatively to the recurring external challenges. Thus, when membership declined sharply, AGPA restructured its base, during Norman Neiberg's presidency, along pluralistic lines. After decades of being a predominantly elite, psychoanalytic movement, the Association opened its doors to all responsible mental health professionals who worked with groups. Needless to say, an equally compelling factor in this expansion was the realization that the earlier, counterproductive ideological parochialism had gone out of date. As was noted in another context (Scheidlinger, 1991), there was a growing awareness among the senior practitioners of all the major therapeutic models that: 1) single system ideologies and techniques had distinct clinical limitations; (2) research had shown that experienced workers from divergent theoretical camps tended to get similar outcomes; (3) the commonalities in all forms of psychotherapy were more impressive than was generally acknowledged; and (4) most seasoned American psychotherapists had come to view themselves as eclectics.
With all major systems of group therapy enjoying equal status, the organization's programs and publications have begun to reflect this new diversity. A variety of ideologies, intervention measures, contexts, and patient populations, featured at the recent AGPA conferences under strict quality controls, have served to draw ever-increasing numbers of human services' professionals to these events. Another example of the new flexibility and openness resides in markedly streamlined membership application procedures. Student and associate membership levels allowing for early entry are a part of this new system.
In the mid-1980s, Leonard Horwitz, AGPA President, spearheaded a novel, individualized, intra-organizational training program to encompass those practitioners lacking access to training sites which are usually located in large cities. This program combined didactic input from annual conference offerings with supervised clinical practice in the "home" communities, under the guidance of AGPA mentors.
As for publications, aside from the phenomenal growth of the International Journal of Group Psychotherapy, to be covered separately, the Association produced a series of highly regarded monographs dealing with research (Dies & MacKenzie, 1983), bibliography (Lubin & Lubin, 1986), the group treatment of children (Riester & Kraft, 1986), of adolescents (Azima & Richmond, 1989), of the elderly (MacLennan et al. 1987), of difficult patients (Roth et al. 1989), and with psychoanalytic group theory and therapy (Tuttman, 1991)--a total of seven monographs to date.
The Influence of Group Therapy's Pioneers
The history of group psychotherapy as a treatment modality which includes its precursors and pioneers lies outside the scope of this chapter, devoted as it is to the history of the AGPA. The broader history of the field is available elsewhere (Rosenbaum & Berger, 1963; Anthony, 1971; Sadock & Kaplan, 1983).
What is of relevance here is the extent to which AGPA's founders had been influenced by these historical figures. To begin with, Slavson, except for some brief references to Joseph H. Pratt as the first practitioner of modern group treatment in 1905, and to Trigant Burrow as the first person to use the term "group analysis," had' little to say about his predecessors other than Freud (Slavson, 1951). This is somewhat surprising since he had known about the work of Paul Schilder (1936) and Louis Wender in New York. As for the latter, Slavson served as a Discussant (together with Alexander Wolf and Jacob Moreno) of a major paper presented by Wender at the 1951 meeting of the Association for the Advancement of Psychotherapy (Wender, 1951).
Alexander Wolf, in contrast, credited his reading of Schilder and of Wender's works as having encouraged him to try group treatment in his private practice. While Jacob Moreno's prolific writings, beginning in 1910, dealt with important themes in group psychology such as spontaneity, role-play, and sociometry, followed by his writing on psychodrama in the 1920s, his direct influence on the early members of the AGPA was minimal. In part this was probably due to Moreno's (1953) disdain for psychoanalysis. More significant, perhaps, was the extreme personal competitiveness and animosity between Slavson and Moreno throughout their lives. Besides Slavson, Moreno was personally known to Wilfred Hulse, Samuel Hadden, and Saul Scheidlinger through contacts at professional meetings. Hadden, an early collaborator of Slavson's, contributed a chapter to a book which Moreno had edited in 1945. At a later point, Hadden (1955) wrote about having been influenced in his early group work by Pratt (1922), a personal acquaintance of his, as well as by Marsh (1935) and Lazell (1921), two other group pioneers.
In their original work designed to study the process of group psychotherapy, Powdermaker and Frank (1953) utilized an eclectic psychoanalytic approach, borrowing from what they considered to be the most desirable aspects of the various contemporary models of group psychotherapy. To quote them: "Our approach to group therapy with neurotic patients had points in common with that of Foulkes, Ackerman, Slavson, and Wolf, and we were influenced in our thinking by Schilder's analytic concept and Trigant Burrow's emphasis on the study of group interaction" (p. 4).
During the 1950s and 1960s there was a cohesive subgroup of Adlerian group therapists active in the AGPA, among them Helene Papanek (1954). They spoke and wrote frequently about Alfred Adler's and Rudolf Dreikurs' pioneering group work in Vienna with children and with groups of parents. This program, begun in 1921, was termed "collective therapy." According to Dreikurs (1959), this collective therapy was a mere by-product of the general group-centered orientation which characterized these early child guidance clinics. After his emigration to the United States, Dreikurs became well-known for his group work in the Chicago school system.
Pinney (1978) visited Boston's Emanuel Church and reviewed the 1905 records of Dr. Pratt's and the Rev. Worcester's groups with medical patients. Pinney (1978) also delved into Schilder's early work with groups at New York's Bellevue Hospital, concluding that Schilder's reliance on transference manifestations and on the interpretation of dreams entitled him to be considered the first analytic group therapist. Donald Shaskan, an early AGPA President, had been a student of Schilder's and wrote a book about him (Shaskan & Roller, 1985).
Aaron Stein, another former AGPA President, who had trained a generation of psychiatrists at New York's Mount Sinai Hospital, was a student of Wender's. He had worked under Wender at Hillside Hospital in New York where Stein subsequently became the Director of Group Therapy. Stein co-authored some papers with Wender, in which they proposed a parallel between Freud's group psychology and the dynamics of group psychotherapy (Kibel, 1989).
The International Journal of Group Psychotherapy is the official organ of the AGPA. Founded in April 1951, it represents, in a sense, the Association's window to the group world outside, insofar as contributors do not have to be members of the AGPA. The editor, whose tenure cannot exceed two consecutive five-year terms, is appointed by the Board of Directors of the Association. He wields almost complete autonomy in the selection of his Editorial Board and in the designing of the Journal's contents.
In the formative years of the AGPA, a number of basic themes characterized the journal's content. The first of these centered on the applicability and clinical efficacy of group therapy as a treatment modality. A large number of practitioners reported on their creative and energetic efforts to establish group programs in a wide range of practice settings including mental hospitals, outpatient clinics, general hospitals, rehabilitation programs, as well as correctional institutions. The patient populations were far-ranging: from children and adolescents to adults with varied psychiatric disturbances, to patients with psychosomatic problems, to homosexuals, and to the mentally retarded and sexual offenders. These <contributions demonstrated the wide applicability of group treatment and the enthusiasm of the practitioners in this relatively new field.
The second theme reflected the need to establish the efficacy of group psychotherapy as a valid form of treatment, consonant with the basic tenets of psychoanalysis. This was especially important since Freudian psychoanalysts of the day were generally intolerant of any approach which was at variance with the dyadic treatment situation with its focus on the probing of intrapsychic conflicts. The issue was formally joined in the Journal in 1958 when Lawrence Kubie, a liberal among the Freudian analysts, questioned whether group psychotherapy could engender as profound are insight into unconscious processes as individual psychoanalysis. He suggested that group treatment might best serve as a "vitalizing antechamber" to the deeper individual analysis. In responding to this article, Foulkes (958) asserted that the group therapy verbalizations were equivalent to free associations and subject to appropriate individual and group level interpretations. Slavson (1958) believed that while group treatment might well be less "intensive" than psychoanalysis, it was uniquely suited to patients with problems in ego functioning. Kubie (1958) was troubled by these discussions, saying in a Rejoinder "... that my questions have been taken up in a, defensive and resentful spirit .. ." (p. 361). A few years later, Fried (1961) demonstrated group therapy's potential to go "beyond insight" in repairing ego-related pathologies. It IS ironic that these apologetic-sounding discussions have given way in recent years to a plethora of papers in the Journal devoted to the unique value of the "here and now" experiential aspects of group therapy 10 reaching "preoedipal" levels of narcissistic and borderline disturbances of patients with arrested emotional development. Glatzer (1962) was among the earliest workers to employ group therapy with narcissistic patients.
Another theme articulated in the Journal during the 1960's pertained to the adaptation of core psychoanalytic concepts to the group psychotherapy situation. The titles, too many for listing, ranged from transference and countertransference, resistance, acting-out, working through to identification and regression. Hand-in-hand with such theoretical productions went other articles dealing with the "how-to" aspects of group therapy: differential criteria for suitability; homogeneous versus heterogeneous groups; the handling of absences, and of dropouts as well as combined and conjoint treatment.
As might be expected, the newly emerging contributions from the so-called British School of Object Relations comprising such group therapy writers as Ezriel (1950), Bion (1959), and Foulkes (1975) found resonance in the pages of the Journal beginning with the 1960s and continuing to the present. They promoted renewed discussions of theoretical issues pertaining to the focus on the group-as-a-whole as well as clinical considerations of the earlier-noted treatment of patients with preoedipal pathology.
As AGPA moved toward enhancing competency and consistency in the training of group practitioners, the International Journal of Group Psychotherapy also showed impressive growth in quality and in the quantity of its readership. By 1975 the Journal boasted 5000 subscribers.
The Journal's 25th Anniversary issue of April 1975 constituted a high point in the transition from its beginning as a provincial publication in April 1951 to a journal recognized internationally for the most sophisticated reporting of the major developments in group therapy theory, practice, and research. In his "Reflections upon the Anniversary," Foulkes (1975) lauded the Journal's"... leading position internationally" (p. 171).
In the same Anniversary issue, Peck (1975), a former Editor, identified two major challenges facing the group psychotherapy movement in the future. The first foresaw a role for group therapy in the promotion of social and institutional changes in the community in conjunction with the community mental health center model and with the therapists' need to help the patient adapt to his institutions. The second challenge concerned the expansion of group therapy's theoretical frame work to make place for the newly emerging group intervention modalities such as family therapy, as well as Gestalt and Transactional Analysis. In line with general systems theory he proposed: "When a patient changes his characteristic mode of behavior in the group, it almost inevitably alters the group's shape and character ... involving the individual members, the group leader and the group as a whole in a circular process wherein change in any part of the system affects every other part, as well as every other group in which each individual participates" (p, 156).
Peck's first challenge disappeared with the early demise of the community mental health center movement. What survived from it in the Journal was a body of theory which tries to integrate psychoanalytic concepts with those of organizational dynamics (Kernberg, 1978, 1984).
These formulations highlighted the personality problems of organizational leaders (i.e., narcissistic and paranoid) as they attempt to provide "rational" leadership.
As for Peck's prediction about the need to open AGPA's boundaries to neo-analytic and non-analytic contributions, he proved to be right on the mark. As we noted earlier, a broadening of ideological perspectives and a loosening of earlier rigidities occurred not only via more diverse publications in the Journal but also at the organization's scientific meetings and in its monographs. While most articles in the Journal still reflected the predominant psychoanalytical model of practice, contributions from the perspectives of transactional, existential, behavioral, and Gestalt groups were included as well.
Despite the field's original reliance on traditional drive theory and ego psychology, group therapists' sights have shifted to include considerations of object relations theory and of self-psychology. This is reflected in the Journal's recent symposia dealing with such themes as Group Treatment of Borderline and Narcissistic Patients, The Group-as-a-Whole Approach, as well as Therapeutic Ingredients-of-Change in Group Psychotherapy. As might be expected, there are still some honest areas of basic disagreement among group therapy practitioners. An example is Scheidlinger's (1987) contention that, given the complex and sensitive function of interpretation in group psychotherapy, it best be reserved for the experienced and trained professional group therapist. Napolitani (1987), in contrast, believes in an egalitarian approach in which the group therapist helps the patients and the group to take over all therapeutic functions including those of interpretation.
In addition to psychoanalytically oriented discussions, the Journal contained a number of articles which were an outgrowth of AGPA s Task Force on General Systems Theory. Thus, Durkin (1981) presented systems theory as a "superordinate" framework for group therapy practice. Within this framework, systems theory is believed to address in a more satisfactory manner the complex, circular interrelationships which encompass the group's effect on individuals, on subgroups, and on the therapist. The individual's effect on the group-as-a-whole and on the therapist as well as the latter's effect on each individual and on the group. Other contributions with a general system's perspective were Beck's and Peter's on leadership roles, MacKenzie's (1979) on group norms, and Slife and Lanyon's (1991) on the power of the "here and now" in group therapy.
In a series of three articles (1982, 1987, and 1990) Grunebaum and Solomon reviewed the relevant literature pertaining to the role of peer relationships throughout the life cycle. They offered cogent ideas about the usefulness of a peer group "history" in evaluating prospective patients for group treatment as well as in the viewing of group therapy as a corrective peer group experience.
As might be expected, since its beginning, the Journal has been a prime medium for the elaboration of Slavson's activity group therapy for children stressing its application to different patient populations and to different settings. In the 1960s and 1970s a growing number of publications began to question the primacy of the original nonverbal, action-oriented approach and introduced treatment models emphasizing verbal therapist interventions and planned group discussions (Epstein & Altman, 1972). Some of these new models were adapted to the unique needs of the growing numbers of children with socially and emotionally deprived backgrounds including impulse-ridden and psychotic ones (Maclennan, 1977). A comprehensive overview of the theory and practice of child group therapy was published by Schamess in 1976.
As for the group treatment, of adolescents- often considered the treatment of choice for this age group-there appeared a similar overview paper by Kraft (1968). Prior to that, Ackerman (1957) had described a successful experience with a co-educational group of adolescents. This paper represented a kind of technical "breakthrough" insofar as group practitioners had heretofore worked with separate gender groups, in the fear that mixed groups would promote excessive sexual acting out.
Many of the early writings in the Journal dealt with therapy groups for delinquent adolescents, who were especially hard to reach in one-to-one treatment encounters. One of these papers was co-authored by Slavson (Altman & Slavson, 1962). In the same year, Feder (1962) wrote about short-term groups for delinquent boys in a residential setting. Most of the authors stressed the need for structure in all group work with adolescents, lest too much anxiety render these groups as unworkable. As might he expected, the papers on work with adolescents almost invariably touched on issues of countertransference, an ever-present phenomenon, because adolescents tend to turn their therapists into allies against their parents and other authority figures. In addition, the adolescent's characteristic openly provocative and "testing" behavior is bound to abrade adult sensitivities and to evoke emotional reactions. For this reason, some otherwise competent group therapists were found to be simply unsuited to working with adolescent groups.
The Legacy of S. R. Slavson
On the occasion of Slavson's 80th birthday, the October 1971 issue of the International Journal a/Group Psychotherapy was dedicated to him, including a special Tribute by Hyman Spotnitz (1971). Having ceased to be involved in AGPA's governance, Slavson had by that time become President Emeritus and Consulting Editor of the Journal, for life. During his rare appearances at major organizational functions he seemed to relish his role of elder statesman.
Slavson died at the ripe age of 90 on August 5, 1981 and was appropriately memorialized by his disciple and long-time collaborator, Schiffer (1983). We believe that there probably would not have been an AGPA without this man's evangelical zeal, drive, and persistence. In the words of Anthony (1971) "... he has instigated group therapy's development as a profession, its recognition as a scientific discipline, and its acceptance as an arena of worthwhile research by behavioral scientists" (p. 24). His tight control of AGPA's direction during its beginning years assured its location in the psychiatric-psychoanalytic realm with stress on solid educational "and clinical requirements for membership. His seminal contributions to the development of group therapy for children and to the group guidance of parents (Slavson, 1950) are unquestioned.
There is disagreement, however, regarding Slavson's lasting contributions to the general theory of group psychotherapy, his prolific writings on the subject notwithstanding. Anthony (1971) for example, thought that"... as a theoretician he is more categorical than creative and there is a positiveness about his position that the state of the art hardly merits" (p. 24).
In our view, Slavson lost credibility because of his tenacious, lifelong denial of any connection between group dynamics and group psychotherapy. It is truly puzzling that this brilliant man and astute clinician, while describing a variety of group processes in therapy groups (using his own terminology), failed to see that many of these processes can occur in all small groups. One wonders here whether his "missing of the boat" (Anthony, 1975) might have been related to more subjective factors. It seems paradoxical that prior to his discovery of the therapeutic potential in children's groups, Slavson was a progressive educator and social group worker, had written a number of books in these fields (1937, 1939), and had even edited a group work journal! Might it be that his excessively emphatic repudiation of these professional roots in group dynamics was essential to protect and insulate his later hard-earned and self-taught role as psychoanalyst-clinician-therapist?
Thus, when Lawson Lowrey (943) referred in public to Slavson's new activity group method as being rooted in "... group work, progressive education and psychoanalysis" (p. 650), he might unwittingly have touched on an issue uniquely sensitive to S.R. Slavson whose covert task might have been to deny the first two of these roots. Interestingly, the above-noted comment of Lowrey's occurred at the very same Special Section on Group Therapy at the 1943 meeting of the American Orthopsychiatric Association, which gave rise to Slavson's convening of AGPA's "founding" luncheon.
A Glimpse at the Future
At a time when other interdisciplinary organizations in mental health are in trouble, it is gratifying to report that AGPA has managed to reach its 50th Anniversary in fine health, with a stable membership and with uniquely successful annual conferences and publications. Its next immediate objectives are within reach: to develop a credentialing system for trained group practitioners and perhaps also to establish a much needed set of Guidelines for the Training of Child and Adolescent Group Therapists to parallel the existing Guidelines for the Group Therapy of Adults.
Given the continued unprecedented expansion of the broader "Group Helping Field," the need for trained group practitioners is bound to grow. Contemporary trends point to an emphasis on homogeneous, short-term, and open-ended groups for people who share similar symptoms or handicaps as in substance abuse, eating disorders, phobias, and chronic disabilities. AGPA members might also find roles, perhaps as consultants and trainers, in the mushrooming area of indigenous self-help and support groups operative all over America. Lieberman (1990) estimated that from 9 to 12 million people regularly rely on some kind of support group.
As for existing paths, the intensive outpatient and inpatient group treatment of patients with impaired early development (i.e., borderline and narcissistic disorders) including schizophrenia, is bound to continue. Renewed focus will be required on the increased need of group modalities for children and adolescents, especially in schools, for medical patients and for the elderly.
As noted by Dies (1992), given the economic realities of our times, calls for pragmatism, integration, and clarification will be the order of the day. Reimbursable clinical practice will move toward greater professional specialization, codification, specificity, cost-effectiveness, and employment of combined therapies, including pharmacology. Long-term group therapy will be reserved for patients in the more affluent private sector, with emphasis on character reorganization, problems of living, and existential concerns. Spurred by the anxieties and alienations of a society caught up in an unprecedented rate of social change, the AGPA and its members will be productively occupied--and preoccupied for at least the next fifty years.
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