By Vivian de Villiers.

Thank you for your warm welcome to the St Petersburg group analytic conference.

It is a privilege to be here and I have again been impressed with the work that you presented here.

My talk differs from my original talk uploaded on your website in that the beginning and end gives a historical context of Alcoholics Anonymous it is shorter and contextualised in my work in addictions.

Let me tell you a story.

Once upon a time there were two men living in America, called Bill and Bob.

Bill Wilson, was a stock broker and Dr Bob Smith, a rectal surgeon and both were addicted to alcohol.

One night, Bill was in a hotel lobby feeling disillusioned an depressed after a failed business deal and hearing the noisy conviviality in the bar, knew that he would find company and cheerfulness in the bar.

However he had been abstinent from alcohol for 6 months and also knew that if he went into the bar for company he would relapse into active drinking.

He started phoning people, from a list in the hotel lobby asking them whether they knew an alcoholic that he could talk to.

Eventually he got hold of Dr Bob’s wife who told him that Dr Bob was not in a condition to talk having been drinking but it was agreed that they could meet the next day.

The next day Bill went to see Dr Bob who said he would talk to him for 15 minutes. However, they ended up talking for hours with Bill telling his own story with alcohol to Dr Bob and the two of them sharing their experiences regarding their drinking and the challenge of remaining abstinent.

This was the birth of Alcoholic Anonymous in 1935

From then on many hours were spent meeting around the kitchen table in Dr Bob’s house drinking coffee and talking, supporting each other in a group with other alcoholics interested in stopping joining them.

I'll come back to this story, the events that led to the birth of AA.

Now moving to today:

I’m a group analyst and have also studied the 12-step model of the treatment of addiction and will now go into some of my experiences of love and aggression of the group and in the group.

Group therapy form a crucial part in the treatment of addiction although one-2-one therapy also has a role.

I'll focus mostly but not exclusively on my work in the NHS in addiction assessment and treatment units.

Love and Aggression of the group in the context of an addiction assessment and treatment unit in the NHS:

When I started work in the NHS, group therapy in the treatment of addiction was still a niche area where one could work with groups, however, the groups were generally delivered by occupational therapists and psychologists.

With love of group I started work and was disappointed when a number of psychologists and a few occupational therapists not infrequently expressed the view that there was no place for group analysis in an addiction treatment unit. The 12-step model of recovery was not considered much better either.

I felt troubled, did we not share the love of group ?

The term “psychodynamic” and “analytic” seemed to cause an “allergic emotional reaction” in some of these colleagues.

I responded defensively. When a colleague used Socratic questioning on me in an effort to challenge how I justified my group analytic orientation in the treatment of addiction, I said in frustration that: “I could fully understand why in the end Socrates was told to be quiet and drink his hemlock in order to stay quiet”.

Of course this was not a comment that would lead to a closer working relationships with colleagues.

After reflection I changed tactics to the obvious by asking colleagues how they defined group analysis. I started to explain how I conducted groups and the value of group members sharing their experiences with each other. This did improve my working relationship with some colleagues. I feel that in the end the value of the group program that I delivered was acknowledged but there remained a sense of suspicion from some staff in the NHS addiction service.

A positive example was one of the psychologists that I worked with who complained that in the interview for his position he made it clear that he did not like groups and that he did not want to conduct groups and did not have the training to run groups.

However, when in post he found that he had to do groups with me and had very few one2one sessions.

He became my co-conductor for a number of years and it was in my view very helpful that both him and I had an interest in films. So, after a group session we would talk about the group we just conducted and also about films.

He left after a number of years to take up another position and sometime later we bumped into each other in a supermarket when he told me that he was now conducting groups in his new position and valued the work we did together.

Love of the group:

Does “love of the group” also mean “trust the group”?

What is meant by “trust the group”?

I feel that “trust the group” is at risk of being used unreflectively as a cliché.

Trust takes time to develop and the context is important.

Trust develops in a step-wise fashion.

In a group, members who have been longer in the group can model group behaviour to new comers.

Members of mutual help groups like AA, often use the term, “the rooms”, when they refer to the meetings or groups. There is certainly affection, trust and compassion in these meetings, but members learn how to use the meetings and not to disclose what would be too compromising.

Membership of a mutual help group comes with a health warning, such as:

Beware of predators, for example of men wanting to seduce newcomer women, and also of course same sex relationship seductions.

Medical treatment is provided by a doctor, so don't accept medical advice from a group member.

Limited self disclosure in the group. Check with your therapist or with one or two members whether it would be safe to disclose something in the group. 

The format of AA meetings are different from group analytic meetings given that a person speak, or share, only once in the meeting and do not challenge each other directly.

This is containing and avoids direct confrontation.

Considering British Doctors and Dentists Groups (BDDG), a support group network, which is attended by doctors and dentists dealing with their own addictions:

Members, especially new members can feel a great relief to hear that others in the same profession also got caught up in addiction and did some similar shame-inducing things. It also gives hope that it is possible to get well and rebuild their lives. There is a significant increased suicide risk and incidence in health professionals suffering from an addiction.

The BDDG groups have a high level of confidentiality otherwise members would not be able to be open and honest and the value of the group would be diminished.

Aggression in the Group.

In my experience it seems that aggression in the groups were mostly used as a defence and I have come to think of it in terms of; “the greater the anger and rage, the greater the pain underneath it”.

One example was a man who was banned from contact with his children by the Court due to his behaviour under the influence of alcohol. Another group member, a man, started talking about his own close relationship with his children, which was unbearable to the first man who became very angry and left the group.

Malignant mirroring events can also occur in work in homogeneous groups, where all the group members have the diagnosis of addiction.

Hearing someone talk about very painful experiences as a result of addiction, which is very similar to the listener, too close for comfort, can become unbearable, especially if the person is still in a position where they feel not ready, or not able to stop.

Maintaining an environment of “optimal frustration”, is an important role of the conductor in therapy groups.

When tensions in the group is very high, the conductor needs to be more active in an effort for the group to remain functional and to avoid group members from walking out. Similarly if the group is functioning at a level of having a “coffee morning” chit chat, efforts from the conductor could help members to engage and discuss what is being avoided.

Love in the group.

Patients were mostly residential in the addiction treatment unit that I've been referring to.

It is inevitable that erotic feelings develop between some patients and we often reminded patients that acting out these on the erotic feelings interferes with treatment.

Often there were group members who in previous admissions got into intimate relationships with negative consequences and they would confirm the importance to remain focused on getting well.

It was also part of the treatment contract that patients signed on admission making it clear that patients who breaks the contractual agreement would be discharged.

However, it was to be expected that some patients became attracted to each other, which was problematic.

The effect of secrets between two or more group members could be seen in the groups in that the groups were more superficial. And not uncommonly our suspicions were confirmed after the involved people left the unit.

This was due to a prison or criminal code of conduct in not “grassing” on each other. In other words, staff were seen as the establishment, or law enforcers and the patient group would not tell on each other.

Some concluding remarks regarding the run-up to the birth of AA.

About 2 years before the birth of AA, an financially well off American, Roland H, went to Carl Jung and spent a year in therapy in an effort to treat his dependency on alcohol.

After conclusion of his year long therapy he left and promptly relapsed.

He went back to Carl Jung, who told him that there was nothing else he could do for him.

However, he said he had seen the occasional person get well by joining and practicing a religion.

So, the American patient, Roland H went back to America and joined a Christian religious order, the “Oxford Group” and remained sober. He influenced Ebby who told Bill Wilson about that.

Early AA members attended the Oxford Groups but they eventually broke away from that and developed their own meetings.

One of the reasons why AA members stopped attending the Oxford Groups and formed their own groups was the Oxford Group’s expectation of absolute honesty, absolute purity, absolute unselfishness and absolute love. AA members felt more comfortable with “progress rather than perfection”. They were also having their own meetings in Dr Bob and Bill Wilson’s house.

During the first 6 months of Bill Wilson’s abstinence he did not manage to help anyone to get sober.

His psychiatrist, Dr Silkworth suggested to him that instead of preaching to people it might be more useful if he shared his own experiences, which he did with Dr Bob. From then on AA developed by talking to each other in a self disclosing way.

In my opinion America was ideally suited for the development of a group based program such as Alcoholics Anonymous given that Trigant Burrow, the first American born psychoanalyst was already in the process of developing the group method of analysis in the 1920’s. He is considered by many the first pioneer of group analysis and Foulkes did refer to him. I feel that the idea or concept of group analysis was already in the foundation matrix or social unconscious of America, which facilitated the development of AA. 

I suggest that the AA meetings is a form of group therapy. However, the AA program of recovery is not only a group program. There is also written work in relation to the 12-Steps, which is then discussed one-to-one with a more senior AA member who is doing well, called an AA sponsor. The step work has a significant cognitive and behavioural aspect to recovery.

In treatment settings group analysis in my view is ideally suited to conduct groups with patients with addictions in addition to the 12-step program. It could be called “applied group analysis”.

References

For talk by: Vivian de Villiers at St Petersburg.

ALCOHOLICS ANONYMOUS WORLD SERVICES, Inc., (1984) Pass it On; The story of Bill Wilson and how the AA message reached the world. New York; AA World Services, Inc.

AVILLAR, Juan Campos., Trigant Burrow, Pioneer of Group Analysis. http://arxius.grupdanalisi.org/GDAP/JCA_Burrow_ENG.pdf

FLORES, P. J., (2004) Addiction as an Attachment Disorder. New York, Toronto, Oxford: Jason Aronson.

FLORES, Philip J., (1997) 2^nd Ed. Group Psychotherapy with Addicted Populations; An Integration of Twelve-step and Psychodynamic Theory. New York & London: Haworth Press.

KHANTZIAN, Edward J., (2004) Treating Addiction as a Human Process. A Jason Aronson Book. ROWAN & LITTLEFIELD PUBLISHERS, INC

KURTZ, E., (1979) A History of Alcoholics Anonymous. Expanded edition 1991. USA: Hazelden.

MOELLER, M.L., (1999) “History, Concept and Position of Self-Help Groups in Germany.” Group Analysis 32, 2, 181 – 194

PERTEGATO, Edi Gatti, and PERTEGATO, Giorgio Orghe, (2013) From Psychoanalysis to Group Analysis, The Pioneering work of Trigant Burrow. Karnac Books Ltd.