Resnik's chapter is on 'Glacial times in psychotic regression' and is the crowning glory of a good book. Resnik describes a group for psychotic inpatients watched from behind a one-way screen by staff members. The material crackles with the eponymous 'fire' of psychotic delusions and hallucinations but also shows the glacial retreats which defend against psychotic anxieties. A patient comments, pointing to an old scar on a finger, 'This is the scar from an old wound. Before awakening an old wound, you doctors ought to know the coagulation time of the patient'. In their foreword to the chapter Schermer and Pines suggest that readers may find Resnik's use of depth interpretation in acute psychosis controversial. I did not. What I found controversial was that Resnik makes little of the possible relation between his approach and the completed suicide of a young female member of the group. His quoting the other patient on possible psychic exsanguination shows his sensitivity, and mention of the observing group providing intermittent practical containment of the patients suggests that he and the watchers were alive to the dangers. I suspect that one suicide in the lifetime of this group is not statistically improbable in comparison with more conventional treatment programmes but I would have liked Resnik to have said more about the group's, and his own, processing of the death.
That systemic view linked with the chapter by Agazarian on developmental phases in groups in which she gives extensive detail of a group. Her blending of systemic and psychodynamic theories has always seemed wise but her practice, as conveyed by the vignettes, suggested that she loses both systemic and analytic neutrality in the pursuit of catharsis. Perhaps it was the use of role-played material, but I felt convinced theoretical synthesis had cost care of the depth experiences of group members.
By contrast, the chapter by Tuttman on responses to aggression from group members, though a hotchpotch of clinical material, felt much nearer to therapists' and patients' experiences and another chapter which linked systemic and psychodynamic theories, that by Skolnick, stood out as a model of how to stay close to material. Skolnick, after using the Wagnerian 'ring of fire' explicitly for the first time in the book, describes an intensive group-oriented therapeutic community for day patients in Washington DC. The material is detailed, both about the patients' experiences and the alternating projection and introjections of affects between staff and patient groups.
British chapters, by Hinshelwood and Gordon, were also excellent with clear and moving detail in patients' material and in analysis of their countertransferences. Both employ Bion's later ideas about thinking. By contrast, Pines's chapter skips around in presenting clinical material and seemed to add little to his existing excellent work on borderline personality organization in group patients.
Overall I was pleased to have read the book critically. There is some consistency despite many differences between contributors: eight of 10 cite Bion, seven cite either sociological or systemic authors, seven cite Freud and seven Foulkes, six cite Winnicott but only four cite Mrs Klein. No chapter is restricted to a single theoretical basis (Gordon comes closest but even he cites Agazarian and Stern alongside his later Kleinians). This eclecticism and pluralism have their costs: I felt some authors cite ideas such as Winnicott on containing more out of obeisance than to convey clear meanings for group therapists. Similarly I found myself bored with repeated words like 'borderline', 'narcissistic' and 'primitive' in what seem to be Protean variations. Surely these words could now be expunged from the psychoanalytic lexicon with very little loss? This emphasized the superiority of the chapters which gave great detail of sessions. Resnik is particularly interesting here because his detail is good, but also because he undercuts its value by leaving unclear what are his intuitions about the inner worlds of the patients and what are their audible statements.
In summary, this is an excellent and thought-provoking book, essential reading for anyone who is interested in group psychotherapy.
© Chris Evans
That links to one of the more disappointing chapters: Kauffman on 'Group thanatropics'. Kauffman argues that death and mourning contain and create the fire of all groups. The existential point is persuasive, often avoided and links with long- running psychoanalytic controversy about the death instinct. Having made this point, Kauffman adds little to the already confused literature on death, mourning, thanatos and groups. Another disappointing chapter was that by Klein and Bernard on cotherapy which says much that is not new about the need for the cotherapists to work on the dynamics of their relationship if they are to work well for their group. Klein and Bernard were more interesting on the need for therapists to do careful work on their relationship with the containing institution, a point that applies equally to sole therapy of groups and is often neglected.