Another installment:
American Psychiatric Association Task Force Report No. 1 - 'Encounter Groups and Psychiatry', continued...
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Dangers of Encounter Groups
Is the encounter group experience psychologically dangerous for participants? Surely this is one aspect of the field that psychiatry is compelled to examine. Although the evidence is distressingly limited, there is no dearth of emotional reaction to the issue. On the one hand, there is a tendency to exaggerate the hazards, and to overstress the dangers of the encounter group techniques. Some psychiatrists who have seen psychiatric casualties from encounter groups have responded by labeling the entire human relations field as dangerous and irresponsible. Right-wing attacks have labeled sensitivity training as a Communistic technique to undermine national loyalty and to encourage sexual promiscuity. School supervisors in California have campaigned on the platform of eliminating the "three s's" (sin, sex and sensitivity) from school systems. A recent 30,000 word entry in the United States Congressional Record(18) unleashes a blistering irrational attack on all forms of human relations training likening it to Bolshevistic brainwashing practices. (The attack, incidentally, is indiscriminate and includes such traditional psychotherapeutic practices as psychodrama and group therapy.)
At the other extreme there is a tendency to ignore or to disregard rather compelling evidence of adverse consequences of the encounter group experience. Many group leaders and growth centers are never aware of their casualties. Their contact with their clients is intense but brief; generally the format of the group does not include follow-up and knowledge of untoward responses to the group is therefore unavailable to them. 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.
The evidence supporting either of these positions is meager indeed. The data relating to encounter group casualties is in a chaotic state and extraordinarily difficult to evaluate. Systematic follow-up studies are scarce. Much of the material is anecdotal and the large number of participants in a group or a laboratory increases the likelihood of multiple reporting: if fifty laboratory participants report on the same negative event, it soon takes on massive proportions. We must keep in mind, therefore, the difficulty of assessing non-systematic studies conducted on groups of different or unknown leadership and composition, using improvised techniques, which meet for highly varying periods of time. One systematic study of the psychiatric casualties at a residential two-week National Training Laboratory at Bethel, Maine, revealed that the psychiatric casualty rate as measured by hospitalization, overt psychosis or a need for psychiatric attention was in fact very slight, (approximately 0.5% of the participants).(17) The NTL Institute records(12) indicate that of 14,200 participants in summer laboratories and industrial programs, only 33 (0.2%) found the lab so stressful that they had to leave the program prior to completion. At another NTL lab, however, one of the authors (I.Y.) noted that approximately 10% to 15% of all the participants consulted the lab counselor, a psychiatrist, for such complaints as anxiety, depression, agitation and insomnia. Three observers report on four two-week laboratories: of 400 participants, six individuals developed acute psychotic reactions. In each group the credentials and clinical training of the group leader were impeccable. Rogers(15) reports that of 600 individuals seen in 40 groups only two (0.3%) developed psychoses.
In a report published in the American Journal of Psychiatry(5) the authors reported that in three T-groups (a total of 32 participants), there was one frankly psychotic reaction, one borderline acute psychotic withdrawal reaction, four marked withdrawal reactions with lack of participation in the group, two severe depressive reactions with withdrawal, two severe emotional breakdowns with acute anxiety, crying and temporary departure from the group, one sadistic and exhibitionistic behavior pattern and four mild anxiety or depressive reactions. (The authors do not, however, describe the nature of the universe from which these three groups are selected. Future studies would be of greater value if they reported the incidence of high casualty groups relative to the entire population of groups.) Another article in the same journal(3) describes a project in which 73 freshman medical students were seen in sensitivity training groups. The authors stated that there was no emotional illness precipitated by the groups and, "in fact, psychiatric consultations are one-half those of last year and one-third those of each of the previous two years."
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.
As we have emphasized, the field defies attempts at generalization. Most systematic studies have been conducted on National Training Laboratory groups; these groups are usually led by well trained leaders who, if not clinically trained themselves, have easy access to a clinician. (Recently the summer NTL labs have adopted the practice of including a resident psychiatrist on their staff.) 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. However, screening or careful selection of well-adjusted participants is rarely attempted and probably unfeasible; therefore it is common for deeply troubled individuals to seek help from encounter groups. Advertisements in free university and growth center catalogues are phrased in such a way as to attract both well integrated individuals seeking personal growth and individuals with major psychological difficulties. 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)"
In addition to actual psychological decompensations, what other dangers are inherent in the encounter group approach? There have been many instances of participants suffering physical injury; some encounter groups focus on the mobilization and expression of rage, and physical fights between participants who have long suppressed rage are encouraged. Severe bruising and broken limbs have been reported by physicians.
Another aspect which has relevance for psychiatry is the overly simplistic approach to behavior change espoused by many encounter group leaders; in the public eye these practices are equated with psychotherapy (for example, as we mentioned previously, the attack on sensitivity training in the Congressional Record clustered group therapy together with encounter group approaches). Many encounter group leaders have adopted a crash program approach, successful in industry, advertising, and some scientific ventures but resulting in a reductio ad absurdum in their attempts to change behavior. The part has been equated with the whole; the naive assumption has been made that if something is good, more is better. If involvement is good, then prolonged continuous marathon involvement is better. If expression of feelings is good (and it plays a role in all successful psychotherapy), then total expression — hitting, touching, feeling, kissing and fornication — must be better. If self-disclosure is good, then immediate, prolonged exposure in the nude (culminating in the members of the group intensively "eyeballing" each others' crotch area(18)) must be better.
Untrained encounter leaders have little concept of specificity of psychological needs. Generally they appear to assume that every one needs the same type of learning experience — to express greater affect, display more spontaneity, chuck inhibitions, etc. Little consideration is given to the fact that some impulse-ridden individuals need the opposite: to learn to delay and to control affect expression. The practice of psychiatry, despite the differences of opinion within the field, is based on a body of knowledge, and psychiatrists have a responsibility to combat the myth which is abetted by wild encounter techniques that psychotherapy consists of doing a bit of everything; we must maintain our usefulness to the public by maintaining our own stability and by directing continuing efforts to research the efficacy of our therapeutic methods. Clearly it is inadvisable for psychiatrists to be swept along by current fashion and to adopt practices which are obviously offensive to the public taste; the burden of proof for the efficacy of such procedures lies with the designers of the innovative techniques.
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.
In summary, although there are apparent dangers in the encounter group experience, no generalization may be made save that, in the hands of some leaders, the group experience can be dangerous for some participants. The more powerful the emotions evoked, the less clinically perspicacious and responsible the leader, the more psychologically troubled the group member, then the greater the risk of adverse outcome. We must especially exercise caution in our evaluation of the overall encounter group field. It is, after all, a very diversified one; there are perhaps as many differences amongst various types of encounter groups as there are between the encounter group and the therapy group. Some groups may be led by competent, responsible leaders who provide a constructive learning experience for the participants; others may be led by wild, untrained leaders who may produce untoward emotional reactions in the participants. Above all we must note that there is distressingly little data; the casualties come to our attention, but the size of the universe from which they arise is unknown: the group participants who have an important, constructive experience are rarely seen by psychiatrists. It is important that psychiatrists study the available evidence, generate new data through research inquiry, and not take the position of responding with a primitive territoriality reflex to the movement as an unmitigated danger which must be curbed or condemned. We must not fail to note that the encounter group field has been a highly innovative one, that it has created techniques for harnessing powerful group forces in the service of education and behavioral change. In a number of ways psychiatry has been enriched by insights and techniques stemming from some parts of the encounter group field; we must not describe the dangers without also noting the promise of the new group approaches.
Encounter Groups and Psychiatry
© American Psychiatric Association