APA Task Force Report: ENCOUNTER GROUPS AND PSYCHIATRY

[Ursus]

American Psychiatric Association Task Force Report No. 1 - 'Encounter Groups and Psychiatry', continued...

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Implications for Psychiatry

Although the encounter group movement has many implications for psychiatry, it has equally important implications for several other fields: organized religion, clinical psychology, industry and education. It would be unwise as well as presumptuous for psychiatry to attempt to thrust itself into the role of a regulating, sanctioning or certifying body. What role, then, can the professional society of psychiatry assume? One clear function is to  establish standards of professional behavior which will serve as guidelines for psychiatrists who regularly or periodically lead encounter groups. Another function is to provide clarification when the activity of the encounter group heavily overlaps the functions of the psychiatrist. For example, some encounter groups or growth centers advertise the experience in such a way as to appeal to individuals with severe emotional difficulties, often raising false hopes of quick relief or cure.

Psychiatrists have with increasing frequency become engaged in the encounter group field. Some psychiatrists lead groups for institutions such as the National Training Laboratories or smaller local "growth centers." Others have begun the practice of leading marathon groups, lasting for 24 to 48 consecutive hours, at their homes or some nearby resort or motel. These groups may consist of patients, both their own and other therapists' patients and/or non-patients seeking some personal growth experience. The group is usually short-lived, lasting a single weekend with no followup involved. (Some leaders may schedule a short reunion of the group weeks later.) Screening is cursory or non-existent and the psychiatrist generally meets the group members for the first time at the marathon session. Widespread advertisement may be used with notices appearing on bulletin boards (for example, in universities or hospitals), or via a mailing list compiled by the psychiatrist. The advertisement is often presented in non-therapy terms; education, personal growth, personal awareness, or self-actualization is generally emphasized.

Several ethical and legal questions are raised by this practice. For example, is the psychiatrist who leads a non-therapy or quasi-therapy group still a physician responsible for the well being of the group members? In our opinion, a physician, even though he involves himself in a group nominally non-therapy in nature, still may not divorce himself from his traditional continuing responsibility to the participants whether or not they are specifically labeled as patients. (Members' expectations may in no way parallel the leader's intentions. Participants may join a human awareness group led by a psychiatrist because of covert expectations of a psychotherapy experience.) Encounter group trainers, for example, NTL trainers, are not legally responsible for possible detrimental effects of the group on a member unless the leaders are specifically advertised as mental health experts. Although the issue has not, to the best of our knowledge, been legally tested, it would seem probable that the psychiatrist retains his "mental health expert" designation even when leading a group which is not specifically labeled as therapy but which may be a potent influence, both positively and negatively, upon the mental health of the participants. Participation should, of course, be voluntary; not only, however, must consent be obtained but informed consent. Individuals may be sent to the group by their parent organization and have little choice in the matter; they feel obliged to attend especially if they perceive that subsequent success in the organization is contingent on their participation. Others may ostensibly volunteer for a group but without the information on which to make a true decision; they may then appear for the group totally unprepared for the degree of personal involvement demanded. The prospective group member should be provided in advance with as much information as possible about the purpose, techniques, duration, and personal demands of the group so they may make a free choice. We would underscore that the contract be continued as a voluntary one; we deplore the practice of some leaders which prevents (by physical means if necessary) a member from withdrawing from a group. The leader should protect the rights of the non-conformist. At times the deviant member must be supported in his decision to leave a group which is noxious to him rather than have his free choice blocked by the power of group pressures which may threaten, humiliate, or ridicule him into staying.

There are several ways for psychiatrists who lead short term groups to exercise professional responsibility. For example, they should continue to be on the alert for possible danger signs and, should a group member need professional help, must personally assume the responsibility for post-group care or refer the patient to a competent therapist in the appropriate geographic area. The psychiatrist should honor his group contract with the members; if the group is designated as an educational, human relations group, he should not, once the group has begun, transform or allow other members to transform the group into a therapeutic venture. He should discourage techniques suggested by participants which he clearly feels are unwise or dangerous.

If a psychiatrist considers referring a patient for an encounter group experience or his opinion is requested by others about the advisability of an individual attending such a group, he must note that for some individuals, especially those near the edge of psychosis, the encounter group experience may be dangerous. He is advised to inquire about the type of group and the techniques and competence of the leader. The encounter group almost invariably evokes strong affect; common sense dictates that the leaders of such groups be experts in human behavior. At the very least they should have sufficient training in one of the mental health clinical disciplines to recognize signs of impending psychological decompensation.

We have previously noted that therapy groups and encounter groups are not synonymous. Highly experienced and competent encounter group leaders who have no clinical training are not qualified to act as group therapists. Conversely, competent group therapists are not, as a result of ordinary clinical training, equipped to lead encounter groups. Required are knowledge of small group dynamics, teaching techniques and a repertoire of structural interventions not generally available in psychiatric residencies; the numerous psychiatrists who have participated in one of the National Training Laboratory training programs will attest to the difference in skills and emphasis. The psychiatrist without specialized training in human relations groups will, almost invariably, fall back upon his clinical skills and conduct the group as a therapy group. The psychiatrist does not have the "responsibility" to the community to lead groups for para-patients — for those normals afflicted with the common "cultural neurosis" of today. The psychiatrist may have a role as a consultant and advisor to the group leaders in order to safeguard the rights and health of the participants. The primary responsibility of the psychiatrist remains that of treating the psychologically disturbed individual and it is for this task he has been trained and for this task he has been given legal authority and responsibility.

The psychiatrist leading encounter groups is well advised to be fully aware of the practices and reputation of his co-leaders and to refuse assignments with individuals whose practice is considered irresponsible or with organizations which sponsor irresponsibly led groups which use some of the offensive tactics described earlier. He should consider whether the presence of his name and his professional background will serve to legitimize the institution and its other endeavors. Furthermore he should make every possible endeavor to screen candidates before the groups, although it is recognized that comprehensive screening may not be possible for both logistical and technical reasons. We would, in agreement with National Training Laboratory guidelines,(19) advise against the inclusion of members who seek out an encounter group to cure or alleviate a severe psychological disturbance or those with a significant history of incapacitating response to interpersonal stress. Applicants undergoing psychotherapy should be advised to consult their psychotherapist before enrolling in an encounter group.  

In summary, the psychiatrist who leads an encounter group has, in our opinion, the responsibility of obtaining the necessary training in group methods, the responsibility of making explicit and then scrupulously adhering to his initial contract with the members regarding the nature of the group experience, and the responsibility of excluding before the onset or during the progress of the group all members who appear to have a high likelihood of adverse psychological consequences. Because he is leading a group nominally considered educative or non-therapy, he does not thereby relinquish his traditional ongoing clinical responsibility to the group members.

The intensive group experience is intrinsically neither good nor bad. In irresponsible, inexperienced hands it may result in a host of adverse consequences; if properly harnessed, however, the experience may be a valuable adjunct in the production of behavioral and attitudinal change. The time is propitious for a research investigation into these issues. The impact of the time-limited intensive group experience on behavior can be determined by systematic research: the temporal parameter is conducive to research inquiry and the research instruments and techniques are currently available. It would be in the best interests of psychiatrists and their patients to foster a research approach to the understanding and application of the intensive group experience.


Encounter Groups and Psychiatry
© American Psychiatric Association

[Awake]

… Some comments on the article.


“The T-group has always been considered by the NTL as a technique of education, not a technique of therapy; the executive head of NTL has, on many occasions, made his position clear on this issue.(2) Many T-group leaders, however, especially a California contingent, gradually altered their definition of education. Human relations education became not only the acquisition of interpersonal skills but the total enhancement of the individual. The shift in emphasis is most clearly signalled by an influential article(21) written in 1962, which introduced the paradigm of the T-group as "group therapy for normals." Juxtapose the concept of "group therapy for normals" with the blurred, often arbitrary definitions of normality and the subsequent course of events becomes evident. Some additional social factors which contribute to the present form and structure of encounter groups are the revolt against the establishment, the decrying of the need for training, the focus on the "now", the "doing of your own thing", and the emphasis on authenticity, meditation and total transparency.”


I wish this article had at least taken SOME issue with this being applied to the Thought Reform model (of which Lewin and the NTL were quite aware) in which the organization is ultimately in control of the definitions of ‘personal growth’ in a therapeutic sense, and as a result there can be no Education/Therapy dichotomy. They are the same thing in this context. When the choice to participate is coerced there can be no assumptions that change is taking place on an individual level, but because of the imposed standards for social interaction.



“The encounter group may be viewed as a social oasis in which societal norms are explicitly shed. No longer must facades of adequacy, competence, self-sufficiency be borne. In fact, the group norms encourage the opposite behavior; members are rewarded by expressing self-doubts and unfulfilled longings for intimacy and nurturance. The group offers intimacy, albeit some times a pseudo-intimacy — an instant and unreal form of closeness.”


This is one point that becomes a huge issue in a forced, totalitarian situation. If these are the enforced social norm this “pseudo intimacy” cannot be avoided. Being ‘genuine’ becomes the necessary game to play, and accurate individual perception of the social reality is not possible.


“Furthermore, many non-clinically trained leaders reject the medical or psychiatric definition of adverse effect; they may assert that the stressing of members to the point of experiencing such extreme discomfort that they require professional help is not a danger but an accomplishment of the encounter group and that these individuals, although they may temporarily appear worse, have in fact undergone a growth experience and will, in the long run, be more fully integrated individuals. The most extreme view holds, with Laing(9) that even a psychotic episode may be a growth experience which permits the individual to liberate himself and to realize his potential more fully. In some quarters, this comes close to the advocacy of psychotic experience as a desideratum of personal growth.”


Y’know, this is one extreme of R.D. Laing’s style of therapy, to actually feed into and exacerbate ones own psychotic tendencies and create full blown psychotic episodes as a healing experience. This may be something many would take issue with, HOWEVER, he also was deeply committed to the idea that therapy should always be a choice of the individual to engage in. He understood the double bind that arises without that freedom. His technique is truly a destructive force without that understanding. I have a good deal of respect for Laing for that, and he has written some interesting stuff.


“A recent letter by two Fellows at the Menninger School of Psychiatry,(11) which was distributed to several heads of psychiatric training programs, describes a T-group for psychiatric residents in which three (of eleven) members suffered psychotic breakdowns, two during the course of the meetings and one seven months after the meetings terminated. Jaffe and Scherl(6) report on two individuals who experienced psychotic decompensations following an intensive T-group experience. The Committee on Mental Health of the Michigan State Medical Society recently conducted a study on sensitivity training laboratories in Michigan because of reports of psychotic breakdowns, exacerbation of preexisting marital difficulties and an increase in life tensions. The committee concluded that the hazards were so considerable that all group leaders should be professional experts trained in the fields of mental illness and mental health.(7)

In a research project on a university campus(10) 209 students participated in 19 encounter groups; 40 students dropped out of the groups (despite the fact that three college credits were offered). The six-month followup of these students is not yet complete, but there were three clearly discernible casualties: one student committed suicide and two students arrived at the emergency room — one in a manic state and the other severely anxiously depressed. At least eight other students decided, after the onset of the group, to begin psychotherapy. The case history of the student who committed suicide reflects the general difficulties in assessing the dangerousness of the encounter group. Since the student killed himself four days after the second meeting of the encounter group, hasty and faulty reasoning would have impugned the encounter group as the responsible agent. However, the psychological post-mortem revealed that the student had been severely disturbed for many months, had reached out for help from a number of sources, had been in individual psychotherapy and in group therapy with trained clinicians and had, in fact, attended a group therapy session a few days prior to his suicide. Furthermore, a review of the tapes of the encounter group meetings revealed that the group had had two relatively dull, low affect, plodding sessions.”


I sort of feel like this comment on casualties is attempting to excuse the results. ‘It could have been the Encounter, or just the patients past history’ (a common argument of TTI proponents.) If we can’t determine if these things are mutually exclusive, should encounter groups in the TTI be allowed to take place? Unfortunately this article does not venture deeply enough to be able to identify the implications of encounter in the case if the troubled teen industry.


“Furthermore, the NTL executives and most trainers make a distinction between the T-group and therapy group; the task of the T-group is intended to be education — education about group dynamics as well as one's interpersonal behavior. However, many trainers and many of the new encounter group leaders make no distinction between encounter groups and psychotherapy; for them, encounter groups are therapy groups for normal individuals….. Encounter group leaders with no clinical training, with no ability to appreciate the seriousness of certain signs and symptoms and with no ongoing sense of responsibility to the participants have precipitated severe neurotic and psychotic reactions. The assumption that a psychotic experience is growth inducing is not a new one in the field of psychiatry, but it is an assumption lacking supporting evidence. It is challenged by the great majority of clinicians whose experience has shown them that the most common effect of a disorganizing psychotic episode on an individual is to leave him with his self confidence and sense of mastery badly shaken. A psychotic experience is a manifestation of illness, not a way toward health and maturity. Mental hospitals "are filled with patients who even after many years have failed to attain maximum benefit from their psychoses! (13)””

… An ignored problem.  


“Some individuals experience difficulty not during the encounter group but after its termination when they reenter their familiar social and professional environment. Many encounter groups make the error of offering an absolute and infallible standard of behavior (unflinchingly honest, spontaneous, and direct) without regard for the time, place or object. Members find the immediate intimacy and the open communication of the encounter group culture so exhilarating that they then attempt, often with disastrous results, to behave in the same fashion in their social and professional lives, only later, or never, to realize the inappropriateness of their expectations. They may jeopardize their relationships to others and experience dysphoria and dissatisfaction with their lives. Some have responded to this by using the group not as an agent to aid them in their lives but as a substitute for life. The encounter group culture thus becomes the "real" world and a new clinical entity, labeled by Carl Rogers as the "group addict," is created: these individuals spend an inordinate amount of time in groups and roam up and down the West Coast to spend every weekend in a group. Experienced group dynamicists are well aware of the re-entry problem and NTL labs, for example, devote time in the group to working on the application of learning to the back-home situation. "Bridgeburning" is another closely related unfortunate consequence. Some individuals, following a high impact group experience, experience an intense dissatisfaction with their hierarchy of values and their life style. To attain the degree of authenticity they seek, many make abrupt and irreversible decisions, forsaking major life commitments by leaving their wives, families and jobs.”


When does this become the paradoxical point of therapy in the TTI? The dissociation of the patient from their ‘old self’, and the creation of a new person that is expected to be stable when re-admitted to the old environment. If the goal is to ‘burn the bridges’ of the old life, and the new ‘group addict’ (by force) identity doesn’t translate, what is one left with?



“Implications for Psychiatry


… The intensive group experience is intrinsically neither good nor bad.”


… Well except in the case of force, in which it is intrinsically BAD, and the only role encounter can take is as a coercive force.






<SQUAWK!>   - Training, Therapy, or Thought Reform in the TTI?  viewtopic.php?f=81&t=31447   Double Bind: Mind Control in the TTI - viewtopic.php?f=81&t=30423


…that was a parrot.

[Jack Andrew]

Keep up the good work bro.This post is really great and I truly enjoyed reading it.Waiting for some more great posts like this from you in the coming days. :jawdrop:

[Ursus]

American Psychiatric Association Task Force Report No. 1 - 'Encounter Groups and Psychiatry', continued... (end of Task Force Report).

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REFERENCES

(1)  Alexander, Franz and French, T.: Psychoanalytic Therapy: Principles and Applications, New York: Ronald Press, 1946.

(2)  Bradford, Leland: in Human Relations Training News, Vol. 1, No. 1, May 1967.

(3)  Cadden, James; Flach, Frederic F.; Blakeslee, Sara; and Charlton, Randolph Jr.: Growth in Medical Students Through Group Process, Am J Psychiat 126:862-667, 1969.

(4)  Gazda, G. H. (ed): Innovations to Group Therapy, Springfield, Illinois: Charles C. Thomas, 1968.

(5)  Gottschalk, L.A. and Pattison, E.M.: Psychiatric Perspectives on T-Gronps and the Laboratory Movement: An Overview, Am J Psychiat 126: 823-839, 1969.

(6)  Jaffe, S.J. and Sherl, D.J.: Acute Psychosis Precipitated by T-Group Experiences, Arch Gen Psychiat 21: 443-449, 1969.

(7)  Jeffries, Benjamin: Chairman, Committee on Mental Health, Michigan State Medical Society, letter, June 9, 1969.

(  Koch, Sigmund: Psychology Cannot Be a Coherent Science, Psychology Today 3: 14-20ff, 1969.

(9)  Laing, Ronad: The Politics of Experience, New York: Pantheon Press, 1967.

(10) Lieberman, Morton A.; Yalom, Irvin D.; Miles, Matt; and Golde, Peggy: Encounter Gronps: Process and Outcome — A Controlled  Study, in preparation.

(11) Lima, F.P. and Lievano, J.E.: Letter, August 27, 1967.

(12) News and Reports, NTL Institute, Vol. 3, No. 4, November, 1969.

(13) Parloff, Morris, Group Psychotherapy and the Small Group Field, Int. J Group Psychotherapy, in press.

(14) Rogers, Carl: Interpersonal Relationships: Year 2000, J AppI Behav Sci 4:265-280, 1968.

(15) Rogers, Carl: cited by Parloff, M.: Group Therapy and the Small Group Field: An Encounter, Int. J Group Psychother, in press.

(16) Rosenberg, Morris: Society and the Adolescent Self Image, Princeton: Princeton University Press, 1965.

(17) Sata, Lindbergh: Unpublished Study, 1967.

(18) "Sensitivity Training", Congressional Record — House of Representatives, June 10, 1969, pp H4666-4679.

(19) Standards for the Use of Laboratory Method in NTL Institute Programs, Washington, D.C.: NTL Institute, October 1969.

20) Vernallis, Francis F. and Shipper, John C.: "Saturation Group Therapy": A summary description of a research study at Olive View Hospital, a hospital brochure published in Olive View, California, May  1969.

(21) Wechsler, I.R.; Messarik, F. and Tannenbaum: "The Self in Process: A Sensitivity Training Emphasis" in Wechsler, I.R. and Schein, E.H. (eds): Issues in Training, National Education Association: National Training Laboratories, 1962, pp 33-46.

(22) Yalom, Irvin D.: The Theory and Practice of Group Psychotherapy, New York: Basic Books, 1970.

(23) Yalom, Irvin D.; Parloff, M; and Rosenbaum, C.P.: Unpublished Data.


Encounter Groups and Psychiatry
© American Psychiatric Association

[dragonfly]