Group Therapy and Social Transformation
This chapter looks at the relationship between group therapy and society. I examine models of psychotherapy and how they need to place clients within a social context. I explore the current state of the world and its impact on the practice of psychotherapy. I consider the possibility that certain forms of psychotherapy can contribute to social transformation. I look in more detail at how group therapy can promote certain healthy qualities in its clients that can enable them to become transformative citizens.
The Medical Model. Let’s step back from the details of psychotherapy and examine what this endeavor really consists of. Originally it grew out of medicine and psychiatry and was intended for the “mentally ill” and other people with rather severe psychological symptoms. Because of these roots, psychotherapy developed according to a medical model which labeled people in therapy as “patients” and identified them as suffering from a disease. Many therapists use medical terms like “prognosis” and “psychopathology.”
However, I personally don’t find medicine a very useful analogy for understanding what happens in psychotherapy. Psychological problems have their own particular character and need their own model, not one borrowed from a different field.
The “Factory Model.” More recently with the advent of cognitive/behavior therapy, sophisticated psychotropic drugs, and managed care, the medical model has been combined with what we might call a “factory model,” which involves an attempt to fix people as if they were malfunctioning machines and to mass produce therapeutic change. This has resulted in efforts to define discrete psychiatric problems that can be cured or ameliorated by either medication or short-term courses of therapy. This approach even spells out how to treat each supposed disease entity in detailed treatment manuals. The person is not treated but rather the “disease.” This can be understood as an attempt to provide some form of treatment when there are limited financial and human resources. However, looked at from a societal perspective, it represents a reduction of complex psychological difficulties to a mechanical model that ignores their human, relational, and social implications.
The Growth Model. Fortunately, there has been another development in the field. More and more people have come to psychotherapists for help in improving their lives in a wide variety of ways. People who don’t have severe enough symptoms to warrant an official diagnosis are seeking help with their marriages or problems at work, or want to overcome social alienation or find more aliveness and meaning in life. In addition, many people who initially came to therapy with specific symptoms have stayed to make deeper changes in their personalities and lives. In other words, psychotherapy has evolved into much more than just a way to treat psychopathology.
In the sixties, humanistic psychology (Maslow 1971) brought a growth model to the field, reflecting this new orientation. This model sees therapy clients as involved in personal growth aimed not only at resolving conflict and pain, but also enhancing their ability to relate to others, connect with themselves, and be alive, spontaneous, creative, and spiritual. Human growth is conceptualized as a path with limitless possibilities. I find this model more compatible with the full range of the practice of psychotherapy.
The Person and Society. However, both these models understand psychotherapy as applying largely to individuals and have little recognition of the relationship between the person and society. Though certain selected theorists (Fromm, 1955; Herman, 1992; Reich, 1970) have made this connection, it has been largely missing from the psychotherapy literature.
In fact, society has a profound impact on the psychology of its citizens. This is obvious in the case of people who are faced with poverty or prejudice, who are addicted to drugs or involved in crime. However, the societal impact on individuals goes far beyond this. For example, it is well-known that the types of symptoms and personality disorders that are seen now in psychotherapy are quite different from those of Freud’s day, reflecting how society has changed in the last century. The dysfunctions and distortions of a society are passed on to its members, affecting them psychologically. If, for example, a society over-values success and under-values caring, this will be reflected in workaholism among some people and poor self-esteem among others.
In addition, the reverse is also true. The psychology of the members of a society has a profound effect on the society itself. Their relative health and their particular dynamics, strengths, and defenses have an impact on social institutions, and can enhance or impede efforts toward constructive social change. Ideally we need a model of psychotherapy that reflects an understanding of the relationship between individual psychology and society.
The Planetary Crisis. Looking at our society historically, we are currently in the midst of a major transition from one era to another (Capra, 1982; Earley, 1997; Harman ,1988). For the last 500 years or so, we have been in a historical era called the modern or industrial era. This has been characterized by the triumph of science and rationality and by an emphasis on material consumption and personal ambition. Like all eras, it has had its pluses and minuses. It has brought us a large educated middle class, personal freedoms, and tremendous technological advances. But it has also fostered a mechanized attitude toward life, where other people, other nations, and the natural world are treated as machines to be controlled, conquered, and exploited. We even treat our own bodies and minds as machines, leading to a loss of our aliveness, earthiness, and spirituality. The modern era has also brought us to the edge of ecological catastrophe because we treat the natural world as nothing but resources to be consumed. The increase in social mobility and the dominance of the market economy have largely destroyed our sense of community, and families are disintegrating into increasingly smaller units, creating vast social alienation.
We are currently in a transitional period where the ways of the modern era have become outmoded and our society is breaking down, causing social and environmental problems. Our very success at controlling the world has increased our population and our technological prowess to the point where they are now causing immense problems. Unfortunately, when we try to solve these problems with this same world view, we only make them worse. However, a new world view is emerging that could lead to a new healthier society. It sees nature as a vast interconnected web of life that has value and beauty in itself (Macy 1990). It sees human beings as precious, emotional, spiritual beings who deserve an opportunity for initiative, creativity, and personal fulfillment.
The breakdown of modern society has led to a profound planetary crisis. We are threatened with ecological disasters (Meadows, Meadows & Randers, 1992) or other crises, any of which could also lead to social disintegration, and few of our leaders have any understanding of this. Our most pressing human concern is to facilitate a transition to a healthier society to avoid societal destruction.
Influence of Society on Psychotherapy. Both our psychological problems and psychotherapy itself have been strongly influenced by the current historical situation. The beginnings of the breakdown of our modern society have greatly increased psychological difficulties. The disruptions of family and community, which are vital forces for healthy child rearing, have resulted in greater psychological problems in our children. This transition has been accompanied by a variety of social problems and anxieties that make living in today’s world more difficult—drug abuse, homelessness, health problems, terrorism, and genocide. These issues contribute in a myriad of direct and indirect ways to the psychological problems our clients bring to our offices.
On the other hand, the modern era has achieved unprecedented success in solving material and technical problems. This has resulted in an increase in leisure and an expansion of our goals for ourselves and our sense of what is desirable and possible. We are no longer satisfied with simply making a living and raising a family. We now want true intimacy in our relationships. We want initiative, responsibility, and creativity on our jobs. We want satisfaction and meaning in our lives. And people come to therapy to learn how to attain these things. Therefore psychotherapy is facing more prevalent psychological difficulties on the one hand and loftier psychological goals on the other.
Psychotherapy is a diverse field covering a multitude of problems, goals, populations, and attitudes toward healing. Different forms of therapy attend to and represent different aspects of this spectrum. Some types of therapy solve only circumscribed individual problems and otherwise contribute to maintaining the societal status quo. Others foster the kind of therapeutic change that not only makes their client’s lives more fulfilling but can contribute to the creation of a new healthy society. The world is in such a serious crisis that if things continue on their current path, we are likely to encounter ecological and social breakdown which will cause immense pain and suffering. Therefore I think that it is our duty as mental health professionals to do what we can to address this global threat to the well-being of all humanity.
Here I will discuss how psychotherapy in general and group therapy specifically can play a small part in promoting the kind of social change we need to move through this transition. As a profession, we can’t address all the immense social issues society faces, and we can play only a limited role in contributing to solutions, but we must do what we can.
Is This Ethical? First let’s consider whether psychotherapy should focus on this area at all. Some people would say that isn’t our job. Our clients come to us for alleviation of pain or improvement in the quality of their lives, and our job is to give them that and nothing more. Anything else would involve introducing our own agenda into the therapy situation, which is not ethical. I certainly agree that if we were faced with a choice between promoting social change and helping our clients, this would present a difficult ethical dilemma. Convincing clients of a certain political viewpoint is questionable. However, this is not what I propose. I see psychotherapy as contributing to social change in two ways: (1) Helping clients develop healthy capacities which will both make their lives more fulfilling and also make them healthier citizens. (2) Educating them about the relationship between their personal problems and society. This doesn’t involve distorting the therapy process or promoting partisan political views. If anything, a focus on social issues can enhance what we have to offer to our clients rather than diminishing it.
Symptomatic Relief vs.
Character Change. Psychotherapy can contribute to either maintaining the
societal status quo or transforming society in a healthy direction. Forms of
therapy that focus exclusively on symptomatic relief or crisis resolution rarely
contribute to real character change at an individual level, let alone social
change. They look only at how to help a given individual feel better in the
moment, not how to make deeper changes in his personality or world view. For
example, if a client comes to therapy with a fear of flying, a therapist might
design a behavioral treatment involving systematic desensitization. This might
actually allow the client to fly, but it wouldn’t address any of the deeper
psychodynamic reasons for his fears, which are probably affecting other parts of
his personality as well. Focusing on these issues would take longer but might
produce deeper changes in the person’s character, perhaps leading to greater
self-esteem or personal power. Even though this more probing therapy doesn’t
address the issue of social change, it is a step in the right direction, because
a healthier person is more likely to contribute to the creation of a healthy
society.
Consciousness Raising. Psychotherapy can contribute to social change by educating clients about the relationship between their personal problems and society, especially about how social conditions contribute to personal problems. This is an explicit goal of feminist therapy dating back to the consciousness raising groups in the seventies, where women explored the relationship between their personal pain and societal oppression of women (Doherty & Enders 1993, p. 377). This kind of education is especially appropriate for problem-focused groups, where the members share similar problems and perhaps relationships to society. For example, in a group for bulimic and anorexic girls, it might be useful to educate them about society’s overemphasis on sexual attractiveness for women and its high standard for slimness. They could learn that this is not the only way for women to value themselves.
Consciousness raising is not restricted to feminist issues. A
group for patients with hypertension or ulcers might educate its members about
our society’s overemphasis on professional success and power as the
measure’s of a man’s (or woman’s) worth and how this can lead to
workaholism and medical problems.
Adjustment to Society or
Health. Some forms of therapy focus more on helping clients adjust to
society rather than achieving personal health, which may require challenging
social norms. For example, suppose Mike
comes to therapy with anxiety about his performance at work. He is actually
quite competent and works hard but is afraid to face his boss in meetings and
presentations where he is being evaluated. The therapy might address his anxiety
about performance even deal with his deeper need to please authority which
derives from his fear of being judged by his father. However, Mike’s anxiety
is also related to an intense need to be successful professionally, which he
pursues to the detriment of his family life and other personal satisfactions.
This need is encouraged by a society that over-values professional success for
men. Will his therapy examine this? If it simply accepts this drive as normal
for a man, the therapy would merely help Mike adjust to society instead of
helping him find a fuller form of mental health..
If a form of therapy promotes what is most healthy for the client rather than helping him adjust to society, then its clients are more likely to challenge destructive aspects of society. In addition, some forms of therapy have built-in values that intrinsically contradict some of society’s shortcomings or lead in healthier social directions. For example, group therapy challenges the individualistic bias of modern society by the very fact that it happens in a group setting. These kinds of therapy can foster personal attributes in clients that make them more likely to contribute to creating a healthy society.
Personal Qualities and Social Institutions. Can this really make a difference? Let’s look at the relationship between the personal attributes of the members of a society and its social and political arrangements. It is well known that one can’t simply introduce democracy into any existing society and have it work. In order for democracy to function properly, the population needs to be reasonably well educated and empowered. They need to be able to discuss societal issues with some understanding, form political parties and other democratic institutions, and take an active part in the governing of their nation. They must have values that include, for example, a belief in the right of citizens to govern themselves and a disdain for corruption. If one introduces democratic forms, such as elections, into a country with an uneducated, disempowered, corrupt citizenry, it will quickly revert to some form of authoritarian government.
The same applies to our current crisis. We must create a new healthy society whose attributes go far beyond democracy as we know it. We need democracy that is much more participatory and cooperative than we have now. We need an economic system that is democratic and ecological. We also need other institutions that are more oriented toward personhood and community rather than bureaucracy and impersonal market transactions. We need families that are more extended and intact. We need personal and societal values that place a premium on understanding and compassion for people who are different from us. We need to value learning and human development rather than economic success and consumption. In order to build such a society, we need citizens who have compatible personal qualities. Though having such citizens is not enough to create such a healthy society, without them the job would be impossible. I will call such people transformative citizens.
Here we explore personal qualities related to social transformation that are promoted by some forms of psychotherapy and group therapy in particular.
First let’s look at those personal qualities of a transformative citizen that can be promoted by some forms of individual psychotherapy.
The Inner Life. One of the problems with modern society is that it is overwhelmingly oriented toward the external material world, with little understanding of the importance of the inner life of the person and its effect on the quality of life. This causes us to value superficialities such as looks, power, and money and disparage or ignore love, creativity, and the quality of relationships. Psychotherapy can introduce people to the depth and richness of their inner world and awaken an appreciation for this side of life. This is accomplished by those types of therapy that focus on what is often ignored in our society—emotions, motivations, desires, dreams, fantasies, and values.
Vitality. Psychotherapy can engender aliveness and vitality, replacing the deadness and mechanical way of living that our society fosters. This happens through the cultivation of what I call “participatory consciousness,” (Earley 1997) which means an immediacy and vitality of experience, as opposed to an overly rational, detached consciousness. Most forms of therapy help clients to be more in touch with their emotions. Certain kinds of therapy (e.g. Gestalt, Jungian, and art therapy) can help increase intuition, spontaneity, and creativity. Other forms can help clients to be more in touch with their bodies (somatic therapies) or open to their spiritual sides (transpersonal psychology).
Our society fosters a kind of deadness in people which may not even be consciously experienced, but because they miss their vitality, they attempt to compensate for it. They may use drugs, alcohol, power, money, status, appearance, or passive entertainment, all of which contribute to the alienation and destructiveness of our current culture. When psychotherapy opens a person to the richness of participatory consciousness, she is more likely to focus her life energy on those vital endeavors that are truly satisfying, such as creativity, community, and spirituality. These activities don’t contribute to ecological and social problems, but instead point in the direction of societal well-being.
Self-esteem. Self-esteem
is related to social issues in a number of ways. People who feel bad about
themselves often try to compensate for this through achievement, power, or any
of the other compensations discussed above, thereby contributing to
competitiveness, consumerism, and other problematic aspects of our society. I
have defined “value” as a basic need to feel intrinsically worthwhile
without depending on any externals, even those that genuinely justify feeling
good about oneself. Therefore forms of therapy that help clients feel a genuine
sense of value rather than a false sense of self-esteem are helping to create
transformative citizens.
Personal Power. One of the things that keeps our society stuck is a felt lack of personal power among its citizens. Many people feel that they have little power over their lives and less power to change society. Therapy often helps people to have more power over their lives, and in some cases, this can help them to feel that they can also change society. However, ideally we needs forms of therapy that would also help clients feel a sense of social power.
Group therapy, especially interactive groups, can foster a number of interpersonal qualities that are relevant to creating a healthy society.
Empathy and Compassion. Too often we treat other people as objects to be used rather than people of intrinsic value who have their own fears, hopes and loves. Many of our institutions see people as bureaucratic cogs in a machine or consumers to be manipulated. This extends to the way we deal with other nations and the natural world. Group therapy can help clients develop their capacity for empathy and compassion for others, through hearing other people’s struggles and pain and learning about each person’s unique inner process. This can play a part in changing this objectification in our society.
Cooperation. Our democratic and economic institutions are all built on competition. Our politics is adversarial in that every special interest group fights for its constituents and the majority takes all. We would be better of with a more cooperative system in which legislators worked together to find the best solutions for a problem taking all people into account. Our national economy is based on competition between firms, and the world economy is based on competition among nations and multinationals. This is not all bad, of course; some competition is necessary and valuable. However, a healthier society will need to be designed more fundamentally around cooperation and synergy. Group therapy helps clients work on their competitive urges and their desires to win arguments or be proven right. Interactive groups especially help clients learn to care about others and to resolve conflicts in a way that benefits everyone. This attitude could help to create a more cooperative society.
Autonomy. Many of our societal difficulties are exacerbated when citizens compliantly go along with destructive cultural norms, outmoded values, manipulative advertising, and demagoguery. In therapy groups, clients are continually struggling with their ability to be autonomous rather than just giving in to the group or one powerful member or the leader. This can help to produce autonomous citizens who can think for themselves.
Problem Ownership. Some of our societal problems derive from the fact that people try to blame others for social problems instead of looking at themselves or our institutions. Minority groups, foreigners, or other nations are used as scapegoats to avoid looking at the problems of our own nation. Group therapy teaches clients to take back their projections and to own their own part in interpersonal conflicts rather than blaming others. This attitude would be very helpful at a societal level.
Appreciation of Diversity. Prejudice and lack of international understanding often derive from a fear of people who are different. In therapy groups, clients learn about each other in depth and gradually come to appreciate others in profound ways Therefore the more diversity there is in a group, the more the clients have an opportunity to develop their ability to tolerate and appreciate people who are different.
There are a number of other personal qualities and insights that are often fostered by conducting therapy in a group setting.
Universality and Societal Problems. In a general purpose therapy group, especially one that contains clients of relatively normal functioning, it soon becomes clear that everyone suffers from various psychological problems. This helps group members to understand that they are not the only ones who are struggling. It also contradicts negative self-images and helps to awaken clients to the fact that our society has shortcomings. When everyone has problems, it becomes obvious that they aren’t due entirely to individual or family issues; social issues must also be involved. Being in group therapy can engender the understanding that our culture needs to be improved.
This doesn’t necessarily mean that we live in a “sick society” as some would say. I believe that our society has its own particular strengths as well as faults. However, we are far from what we could be, and we are experiencing a host of problems during the current planetary crisis.
Group Culture and Societal Culture. Once a group has developed a therapeutic group culture, it becomes clear to group members that the group is a better place in many ways than the outside world. This can trigger an understanding of the need for social change. Why can’t our society be as safe, open, caring, and honest as a therapy group? Of course, a therapy group is a specialized environment, and it wouldn’t be appropriate for a society to have the same norms as a group. However, we would all be better off if our society bore a greater resemblance to a healthy therapy group..
When group members are encouraged to have outside contact with each other, this gives them the opportunity to extend the group culture into their ordinary lives in a natural way with other members. This paves the way for them to do this with others in their lives. Many group members who are entering the world of therapy and personal growth for the first time become excited about this new way of being and relating; some resolve to extend it to all aspects of their lives. They change their way of relating to old friends and develop new friends who share their commitment to personal growth. They may let go of friends who don’t want to relate in this way. I find this encouraging because it means they have the courage to reshape the fundamentals of how they live. If enough people do this, it will contribute to changing society in ways that are needed.
Community. A good therapy group is a close-knit community. The members understand and care about each other and participate in each other’s lives. Even if members don’t have outside contact, the group forms a kind of community. If they do have outside contact, this can deepen their involvement with each other. Most important, this sense of community provides a model for what is possible in people’s lives. It gives them a taste of the experience and some tools to help make it happen. Since community is so seriously lacking in today’s world, this can encourage group members to create it for themselves in their lives, especially after they leave the group.
Group therapy cannot begin to do all that is necessary for social change. It can’t even accomplish the entire job of developing the personal qualities that are needed for social change. There are some qualities of a transformative citizen that cannot easily be developed through group therapy. For example, because of our immense ecological problems, it is very helpful if citizens have an intimate felt connection with nature that will be reflected in their attitude toward ecological issues. Ordinary therapy doesn’t help with this; it is the goal of the new discipline of ecopsychology (Roszak 1992). In addition, our citizens need to have a greater awareness of societal problems, processes, and solutions, and this is unlikely and perhaps inappropriate for a therapy setting. Furthermore, social transformation requires much more than just change at the individual level; our social values, institutions, and political and economic structures must also change. Nevertheless, even though group therapy can play only a small part in social transformation, it is important that we do what we can.