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APA Task Force Report: ENCOUNTER GROUPS AND PSYCHIATRY

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Ursus:

--- Quote ---2. Some practicing psychiatrists are heavily involved with encounter groups: they lead them, they participate in them as members, and they refer their patients to encounter groups as a technique to accelerate therapy. (Some psychiatrists, in fact, accompany their patients and participate as a member in the same encounter group.)[/list]
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Lol... Talk about a potential conflict of interest!

Ursus:
Another installment:

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

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The Meanings Behind the Surge of Popularity of Encounter Groups

The evidence suggests that there has been a recent sharp increase in the number of small groups which, in a variety of ways, encourage expression of strong affect, intimacy and, often, an examination of intra- and inter-personal behavior. What are the sociological and psychological forces responsible for this phenomenon? We suspect that the groups have arisen in response to a pressing need in our culture. The California milieu which has been the most potent incubator of the new groups has certain clear characteristics. Because of the enormous migration to California in recent years, many Californians have no roots, no sense of permanence, no wellsprings of intimacy. Geographic and social mobility are the rule rather than the exception. The extended family is rarely available; the stable primary family uncommon (one of two California marriages ends in divorce); the neighborhood or work group has diminished in importance as the average Californian changes homes (and often jobs) with bewildering frequency; the neighborhood merchant, the family doctor are rapidly disappearing and organized religion has become irrelevant to many young people. In short, the cultural institutions which provide for stability and intimacy have atrophied without, of course, a concomitant decrease in the strength of human needs. Americans continue to require attachment and sustenance but must often disguise or submerge these longings in the service of adaptability to a swift-moving, ever changing competitive culture.

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. Because of the inexorable automation accompanying technological advance and because of the environmental pressures fragmenting nuclear families, modern man not only seeks intimacy but also wishes to avoid separation and/or loss for which he is particularly ill-prepared. The encounter group offers a unique form of intimacy — one which has no commitment to permanence. In this one may draw a comparison with vacation or convention behavior which is often characterized by a degree of disinhibition permitting us to form intimate relation -ships far more quickly than in our back-home culture. One can commit himself to others more rapidly and fully if there is an understanding, even an unconscious one, that the relationship is time-limited; for one thing there is less need to deal with separation and loss since impermanence had been decreed in advance. From this point of view, then, the encounter group offers immediate gratifications without the responsibility inherent in the long term relationship and without the pain of separation.

Members attend encounter groups not only for affective supplies but for "self-validation"; we are intrigued by and drawn towards an opportunity which permits us, as adults, to expose ourselves, to be examined and to be approved. A great majority of individuals, though they be functioning competently, nevertheless have some deep concerns about their adequacy; few other institutions offer us an occasion for what appears to be a comprehensive final examination of our status as human beings and many individuals attend encounter groups with the hidden agenda of finding out: Am I acceptable? Am I lovable? Do I match up to others?

Young adults, scions of the television set, may be particularly starved for such interaction and feedback. It is well known that the present younger generation has spent as much time before the television set as in the classroom; viewing is a passive and isolating experience which may result in a communication deficiency met, in part, by the basic encounter group. In the past century, the onset of biological puberty has gradually moved to earlier years, whereas the duration of technical education has gradually lengthened. Consequently the proportion of students in an "in-between" stage has increased: they are biologically mature but socially and professionally unprepared. Without indications of their personal worth, without clearly defined roles, or future roles which will be their basis for self esteem, students are restless and searching. The encounter group offers an opportunity to explore with others their role confusion and their uncertainty about personal worth.

Throughout history small groups have flourished in times of rapid social change when old values and behavior patterns were no longer working and individuals were forced to reexamine and redefine their value systems. Many enlightened individuals, abetted by increased literacy, education, and leisure time, are aware in themselves and others of a discrepancy between values and behavior; they espouse humanistic, esthetic, intellectual and egalitarian values and yet under self-scrutiny find that they and their entire culture often neglect these and instead base their behavior on the values of aggrandizement, viz, material wealth, prestige and power. Small groups appear to many young people to offer a new, more consistent microculture; the groups serve as a refuge from the larger society and as a basis from which to gain new perspectives on it.

Small groups have always served as an important healing agent; from the beginnings of recorded history, group forces have been used to inspire hope, increase morale, offer strong emotional support, induce a sense of serenity and confidence in the benevolence of the universe, all of which serve to counteract psychic and many bodily ills. Religious healers have always relied heavily on group forces, but when healing passed from the priestly to the medical profession, the conscious use of group forces fell into a decline concomitant with the rise of the sanctity of the doctor-patient relationship. Despite the official acceptance of group therapy as an effective therapeutic procedure, the number of psychiatrists using group therapy in their treatment of outpatients is very small indeed. Perhaps the recrudescence of group approaches outside the medical profession is in part a reflection of the failure of physicians to make adequate use of them.


Encounter Groups and Psychiatry
© American Psychiatric Association

Ursus:
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

seamus:
Interesting arguement! however the subjuct of SELF DETERMINATION is never mentioned..and the audience that those seminars are directed to are ADULTS. this having been said,how much of it has to do with the therapy via coercion that so many of us suffered,as children. I think we digress here.Didnt certain adults PAY to go to "encounter groups". What happened to free will? its one thing to pay,and go oneself. And quite another to sign a child in and write a check while sayin' bon chance,mon frer. Would one expect a child to take away the same message as an adult? Exactly what would be the most probable outcome of such a situation?
So just take the idea of this half assed therapy leading to a well, short term , fleeting and tempoary change. Hmmm.....once the shine wares off a subject will most likly be left with,huge self doubt,a feelin that he/she had been given a "bum steer",a certain amount of introspection, and x amount of anger.so one might say a certain emotional pendulum has gone both to,and fro. Where does it REALLY leave a subject? Could one suppose how a body could be confused at the prospect of finding out,that the truth had feet of clay?Or angry.....or depressed......

Ursus:

--- Quote from: "seamus" ---Interesting arguement! however the subjuct of SELF DETERMINATION is never mentioned..and the audience that those seminars are directed to are ADULTS. this having been said,how much of it has to do with the therapy via coercion that so many of us suffered,as children. I think we digress here.Didnt certain adults PAY to go to "encounter groups". What happened to free will? its one thing to pay,and go oneself. And quite another to sign a child in and write a check while sayin' bon chance,mon frer. Would one expect a child to take away the same message as an adult? Exactly what would be the most probable outcome of such a situation?
--- End quote ---
Yep. I totally agree with your take on how encounter groups can potentially really mess with concepts of free will and self determination, certainly more so when you are an adolescent. Opting for an encounter group experience implies that one can opt OUT as well. Not so when you're stuck in a program!


--- Quote from: "seamus" ---So just take the idea of this half assed therapy leading to a well, short term , fleeting and tempoary change. Hmmm.....once the shine wares off a subject will most likly be left with,huge self doubt,a feelin that he/she had been given a "bum steer",a certain amount of introspection, and x amount of anger.so one might say a certain emotional pendulum has gone both to,and fro. Where does it REALLY leave a subject? Could one suppose how a body could be confused at the prospect of finding out,that the truth had feet of clay?Or angry.....or depressed......
--- End quote ---
Personally, I tend to think a good part of that "shine" is due to all the endorphins and adrenalin released into your bloodstream during circumstances of crisis. Seriously, I think some folks can get "addicted" to that!  :D

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