A workshop at the Esalen Institute in Big Sur, California, 12 September 2012, on the the institute’s 50th anniversary. Photo By Michael Macor/The San Francisco Chronicle/Getty


Analysis for the people

Group therapy promised to be both democratic and radical, but it failed to take hold. Has its time finally come?

by Jess Cotton + BIO

A workshop at the Esalen Institute in Big Sur, California, 12 September 2012, on the the institute’s 50th anniversary. Photo By Michael Macor/The San Francisco Chronicle/Getty

The Austrian-born psychoanalyst Marie Langer began to think about how psychoanalysis might work in a more collective form in the mid-1950s. She had grown up in the politicised culture of ‘Red Vienna’ and – though trained in Freudian and Kleinian orthodoxies – her communist politics increasingly drew her to an emerging field of group analytic therapy. After emigrating to Argentina during the Second World War, Langer began writing on this new kind of therapy, publishing the first book in Spanish on the subject.

Looking back on her career in 1983, Langer and her colleague Ignacio Maldonado told an interviewer:

We work in groups not only because in a society that desires the integral development of all, individual psychotherapeutic attention is insufficient, but because problems and mental suffering are generated in groups and it is in group situations that they can best be resolved. Group activity … strengthens solidarity and teaches people to view their pain in social terms and to alleviate it together.

In the long run, Langer believed, group therapy could bring about ‘structural change’.

In the mid-1950s, Langer analysed a group of women who shared a common symptom: they’d all struggled to conceive, despite there being seemingly no physiological impediments to their pregnancies. Langer was interested in how these women’s bodily responses might have been conditioned by their social position and fraught feelings towards motherhood and identity. Like Langer herself, many of the women were European exiles who had a complicated relationship to the motherland. Rather than analyse the women individually, Langer wanted these women to view their complex feelings about childbirth through the filter of the relationships they formed with each other in collective analysis.

Langer documents how, over a series of weeks, the participants came to identify with one particular woman, whom she calls ‘The Marked One’ (in part on account of her skin depigmentation). The most promiscuous of the women, and a former actress and prostitute who’d had numerous abortions, she was the object of shared hostility and guilt among the group. As the women assumed a group identity, it became clear that their individual feelings of failure or ambivalence stemmed from a shared psychosocial condition; that a collective anxiety about femininity and reproduction pulsed behind the medical establishment’s inability to fulfil their desire to be mothers. Shortly after these feelings were acknowledged in the group, ‘The Marked One’ became pregnant.

Langer forged revolutionary mental health movements in Nicaragua, Mexico and Argentina

There’s something a little fantastical, even cultish, in picturing these women working through their anxieties collectively, seeking to remedy infertility through psychoanalytic means. Usually, in group analytic therapy, participants have little in common: symptoms emerge and enter the group dynamic along the way. But here, the symptoms drive the form that the group takes. This is a group anxious about fertility, as Langer herself was, having miscarried while volunteering with the International Brigade during the Spanish Civil War. Langer came to see her miscarriages as psychosomatic; indeed, her group analysis upheld some fairly conservative assumptions about motherhood, sexuality and the nuclear family. Later, once exiled from Argentina for her political associations, Langer adopted a more politicised model of group therapy that allowed her to question these assumptions (in keeping with other radical groups of the 1970s). In this switch, Langer was influenced by R D Laing and a growing set of countercultural and Marxist analytic movements that championed a more social psychoanalysis as a way to open up the relationship between psychic states and political change.

By including more than two participants in analysis, and also swapping the private space of the clinician’s office for the public realm of hospital rooms and community centres, Langer broke with psychoanalytic convention. In 1971, she presented a paper at the International Psychoanalytic Congress in Vienna on the potential of psychoanalysis to bring about collective change, under the provocative title ‘Psychoanalysis and/or Social Revolution’. Both the International Psychoanalytical Association and the Argentine Psychoanalytic Association refused to publish it.

The traditional psychoanalytic community was deeply hostile to any therapeutic practice that might breach the ethical framework developed around one-to-one analysis, a framework built on the pillars of patient confidentiality and – transference notwithstanding – the neutrality of the analyst. And so Langer, who was more interested in understanding mental health in social terms, left, along with 22 colleagues, and regrouped under the Argentine Federation of Psychiatrists, which positioned psychoanalysis as a revolutionary force and prioritised group work. Langer forged revolutionary mental health movements in Nicaragua, Mexico and Argentina that aligned themselves with campaigns for political reform, and fostered a vision of psychoanalysis that facilitated progressive social movements.

If these progressive group analytic methods remain, by and large, a kooky and peripheral wing of psychoanalysis, might they nonetheless have the potential to bring about the structural change that Langer envisaged? Might group analysis offer a genuine alternative to a bourgeois practice that has been largely the prerogative of a wealthy few?

Langer was far from alone in experimenting with group analysis in the middle decades of the 20th century. While visiting England in 1945, the French psychoanalyst Jacques Lacan (who would be expelled from the International Psychoanalytic Association in 1963, in part for brutally truncating the length of the analytic session) noted in almost utopian terms the innovations that had occurred in British psychoanalysis during the Second World War. To play with the psychoanalytic frame, as he saw it, is to radically expand who psychoanalysis is for: ‘group analysis’, he wrote, is ‘a revolution which transports all our problems to the collective scale’.

Lacan was thinking, in particular, of how group analysis might, at the moment of the founding of the British welfare state, provide a model of psychoanalytic provision for all – a significant departure from the long-lasting idea that analysis is a privilege afforded only to the middle classes. It would not only have a social dimension (thus making it less shameful for those who don’t come from a class that is expected to get psychic attention) but would be an integral part of social citizenship.

So inspired was Lacan that he wrote of ‘the miraculous feeling’ of rediscovering Sigmund Freud’s work all over again: the emergence of group analysis as no less than a second chapter in the history of psychoanalysis, every bit as important as its founding at the turn of the 20th century. Freud, of course, never worked with groups – though his endorsement of free outpatient clinics that sought to extend psychoanalysis to the working-class communities of Europe after the First World War suggests an interest in connecting psychoanalysis with social justice. Freud also wrote about the psychology of groups, in reflecting on people’s collective desire for the intoxicating force of a strong leader. And yet, even as he acknowledged that postwar psychoanalysis had done ‘nothing for the wider social strata, who suffer extremely seriously from neuroses’, Freud remained wedded to the strict one-on-one precepts of psychoanalysis he’d outlined in the early 1910s.

In this group structure, the analyst is positioned merely as a ‘conductor’

The group analysis that led to Lacan’s rapturous insights was the result of a series of experiments in British military psychiatry, designed to respond to the need to scale up psychoanalytic provision in the face of wartime emergency. The turn to group analysis was grounded not in any utopian social principle, but emerged instead as a practical way to manage a military population. It was vital, as Wilfred Bion writes in his study Experiences in Groups (1961), to ensuring rehabilitation and keeping up a ‘good group spirit’. Bion remains one of the most influential thinkers in group analysis, and at Hollymoor Hospital in Birmingham – the largest military psychiatric hospital in England during the war – he set out, along with the psychoanalyst John Rickman, to treat neurosis through group therapy in a 600-bed rehabilitation unit.

Bion’s aim was twofold: to provide effective psychiatric treatment in a hospital beset by overcrowding, and to encourage the men to take a more active role in their recovery, reminding them they were soldiers rather than patients. By distancing himself from a position of authority (which the analyst naturally assumes in one-to-one analysis), Bion created a situation where the men had to work out a power structure of their own. Bion saw this group structure, in which the analyst is positioned merely as a ‘conductor’, as a way of encouraging a less authoritarian kind of power structure; but it was nonetheless directed towards a larger project of military and social compliance.

As group analysis grew increasingly entangled with the state’s capacity to ensure its own health, it became an extension of the administrative arm of the welfare state. As such, its postwar modes of organisational harmony, notably the Tavistock Centre in London, where Bion and his colleague S H Foulkes institutionalised a model of group analysis, would prove central, both to the postwar vision of the nation as a ‘therapeutic community’, as well as to postwar institutional management culture.

The German-born Foulkes, who’d joined a consulting practice in Exeter in southwest England in 1939, experimented, along with his colleague Eve Lewis, in leading men’s and women’s therapeutic groups. ‘During the past year,’ Foulkes wrote in a letter to the military psychiatrist J R Rees in 1942, ‘I have introduced a new method of psychotherapy in groups with very encouraging results.’ He surmised that if psychoanalysis works through free association – by allowing the mind to wander – then it should work on a group level, as a ‘free-floating discussion’. Part of this innovation was driven by numbers – the consulting practice covered three counties, and Foulkes notes how the demand to provide therapeutic provision on a mass scale, in wartime conditions, pushed him from his training in psychoanalysis, understood in its strictest form, into the broader realm of psychotherapy.

Foulkes had trained in medicine in Frankfurt and was influenced by Herbert Marcuse and the Frankfurt School. When he set up these groups in 1941, he had already spent several years thinking about the inherent possibilities of collective treatment. It turned out that his experiments ‘far exceeded our expectations’, as he and Lewis wrote in a 1945 paper. ‘Not only is it an economy of time for the therapist, while enabling him to devote even more time to each patient, but at the same time it actually intensifies the effect and thus shortens the duration of treatment.’

We depend on one another not simply to be kind, but to allow us to see ourselves

In an interview for an American documentary on group therapy in 1975, at the height of its popularity in the United States, Foulkes said he was sure that Freud would have said ‘baah’ to the concept of group analysis: ‘He would never have thought at this time that one could do serious therapy in a group.’ Foulkes saw in the crossing of a Freudian and a Gestalt approach (which prioritises a more experiential form of analysis) a creative opportunity, rather than a tension. Foulkes also suggested a different temporal distinction between individual and group analysis. Whereas the former changes the individual through ‘the reconstruction of much of the past’, he explained that, in groups, ‘the emphasis is shifted to the present situation’.

Foulkes’s groups started off more or less as discussion groups – as ‘an alternation of separate case-studies’. Initially, as in many accounts of group analysis, silence holds the group in suspension; boredom brews, and participants struggle to form attachments with one another. Then, as the weeks progress, fraught emotions begin to surface: one member of Foulkes’s women’s group reports that for half an hour she had wanted to scream because she knew another member ‘wanted to, and she felt like screaming for her’. She does ‘not sympathise in opinion with’ this woman ‘but felt her emotion like an electric shock. She had to keep stretching herself and stuffing her hands into the couch to stop screaming’. When group analysis works, participants carry, and sometimes express, other members’ emotions so that the person mirrored is faced with a psychic state they have not yet reckoned with.

We are used to thinking of emotional relating in terms of empathy, yet group analysis reveals that our relations to one another are far more complex. We depend on one another not simply to be kind, but to allow us to see ourselves; to experience ourselves as social creatures with an array of fraught emotional histories and aggressive projections that we only just conceal in order to get through ordinary daily social interactions. One of the woman’s chief symptoms is loneliness, a state driven in part by her sense of geographical and social isolation, and her difficulty in speaking (she requires an operation that she has been putting off, but that she gradually, over the weeks, commits to). As she allows herself to participate in the group, her symptoms slowly improve.

In the US, group therapy took a very different trajectory. At its extreme, it embraced a variety of almost cultish incarnations that were frowned upon by the analytic community. At the Sullivanian Institute on the Upper West Side in New York, members of an urban cult were offered group therapy alongside the countercultural package of parties, sex and low rent. Group analysis also burgeoned in eccentric, hippyish forms at the Esalen Institute, at Big Sur in California, many of which combined the precepts of Mitteleuropean analysis with some of the wackier elements of existentialism and Zen Buddhism. At Esalen, Fritz Perls, the founder of Gestalt therapy, encouraged workshop participants to project aspects of their personalities into the room where he would address them in an attempt to recoup their splintered, lost selves and so transform them into a Gestalt or whole. Perls’s workshops aimed to awaken greater consciousness, and drew on techniques of psychodrama that originated with Jacob Moreno in Vienna in the 1910s, as well as on Wilhelm Reich’s ideas of bodily liberation.

Where Bion and Rickman sought to make the psychoanalyst an invisible participant who allows the leaderless group to generate its own form, Perls took on a much more active role. Like a magician, he would isolate a psychoanalytic block or complex and reveal it before his stunned audience, who become essentially spectators of one another’s inner world. In the 1960s, Perls declared individual therapy obsolete, and threw in his lot with group analysis, explaining that the ‘collective conviction of the group’ can create a ‘safe emergency’ through which ‘the neurotic discovers that the world does not fall to pieces if he gets angry, sexy, joyous, [or] mournful’. The group, especially in its most extreme psychodramatic versions – which includes primal screaming – has something of Brechtian theatre about it. It serves not simply as a sounding board for individual psychic ills but as an artificial frame at once stranger and more intense than everyday life.

They were a kind of analysis without the analyst, as if therapy could be removed from its institutional history

By any reckoning, these group therapies break with the ethical framework of psychoanalysis, creating a situation of ‘professional anarchy’, as Renata Adler noted in The New Yorker in 1967 in her report on the new fad for all things ‘group’. In other words, group therapy is a much more ‘disparate and eclectic’ practice than group analytic work. Adler predicted that, despite its theoretical unruliness, group therapy would find a distinctive place in postwar US life. It would become a routine affair, like going to the gym.

A psychotherapist-guided group replays scenes of trauma and neurosis; Paris, 1973. Photo by Manuel Litran/Paris Match/Getty

But in the immediate years that followed, psychodrama – like free love – fell out of fashion, and group therapy found its popular footing in ‘encounter’ groups, which emphasised processes of ‘being’ and ‘becoming’ and attracted people interested in personal growth and self-actualisation. T- or training groups were their industrial equivalent – a style of emotional learning where members of a small group are encouraged to become alert to their own reactions, perceptions and behaviours so that they might work more productively together. They were a kind of analysis without the analyst, as if therapy could be removed entirely from its institutional history and its interest in emotional complexity. Widespread in the 1960s, encounter and T-groups have since dissolved into industrial and social organisational strategies, and the wellness industry.

Some of the more cultish, popular forms of group therapy that were prevalent in the 1960s were taken up and reworked by the women’s and Leftist movements of the 1970s. While group therapy often risked charges of ethical and cultural malpractice, it was group therapies’ unorthodox approaches to psychoanalysis that allowed feminists to suddenly find a way into psychoanalysis that did not seem too dependent on what was widely conceived as the patriarchal model of Freudian analysis.

The ‘trajectory from feminism into the therapy world was the same for me as for lots of women and community activists of my age. It was a very common way of moving at that time because the personal is political.’ So said the London-based group analyst Sue Einhorn, recollecting that time of foment and innovation. In the same interview from 2019, Einhorn, who qualified as a group analyst in 1991, laments that talking about politics and group analysis is ‘rather painful for me because I think that group analysis has never really grasped its political focus … and has increasingly betrayed it …’ At the heart of the idea of group analysis as Einhorn sees it, is ‘a very deep understanding that there’s no such thing as an individual. We’re all part of the social in which we live.’ But this reckoning with the social has been sidelined in the focus on the analytic institution. For Einhorn, ‘the competition between the men in group analysis meant that for a long time it wasn’t a dialogue about developing Foulkes’s ideas, it was about who owned the social unconscious.’ She regrets not owning her own identity as a feminist more in these circles.

In many ways, the 1970s was one of the most exciting decades in the history of psychoanalysis because it fostered so many grassroots models and collective forms that came together to imagine a type of analysis that might work for the people and be grounded in social change. In the women’s movement, an analytic professional was sometimes brought in to lead groups. Often, they drew on Freudian, encounter and Gestalt approaches but, at other times, the groups were truly leaderless and productively chaotic. These provisional forms of group analysis modelled a radical vision of what psychoanalysis might be, even if they invariably proved difficult to sustain long-term. What was most innovative about these grassroots models is that they situated individual psychic discontent in a social setting that allowed women to see how their feelings of anxiety and ambivalence might have a social origin and to muster the political tools to transform the world around them. In their collection In Our Experience (1988), the editors Sue Krzowski and Pat Land write that: ‘It was often a startling experience to identify for the first time a personal shame or anxiety as part of a social reality, and it made changes in many women’s lives.’

The psychoanalytic establishment continues to view group therapy as implicitly less valuable

The grassroots therapy groups were frequently allied to local community practices, such as nursery provision or women’s shelters, so that analytic group practice could be properly rooted in the community. Such groups were difficult to sustain as the 1980s progressed, amid rent rises and social welfare cuts, and with the idea of the individual becoming ever more central to socioeconomic prosperity. But they had a lasting impact on therapeutic culture, leading to the creation of community-based groups such as the Women’s Therapy Centre (WTC) in London, which ran for more than four decades until it was forced to close in 2019 due to lack of funding. In particular, the WTC offered therapeutic provision to women on very low incomes who find it difficult to use normal mental health channels and who tend to fall through the usual safety nets. As one single mother, who had been living in a refuge for 15 months, explained in an interview dating from 2014, she had felt very lonely before participating in the group. But the group provided her with a collective way to heal, and so the depression and anguish she felt – as a lone mother, in a foreign country, without a home (‘the nightmare’) – had now gone.

In spite of the growing crisis in mental health care provision, exacerbated by the COVID-19 pandemic, the psychoanalytic establishment continues to view group therapeutic methods as by and large unorthodox, as diluted or left-field versions of the talking cures: as a form of therapy that is always implicitly less valuable. The hangover associations of groups with cults or fads, eccentricity or even brainwashing linger on too, in the public perception of group analytic therapy, which has ultimately failed to occupy the collective psychic space in the same way that individual and indeed couples therapy have in recent years.

Psychoanalysis is a kind of mirror space. A topsy-turvy world. A creative illusion through which, if it is successful – and we have to concede that it is not always – one experiences moments of breakthrough. Long-held assumptions of who we are jostle and shift before us, releasing us from a history that has been imposed on us, and allowing us not only to adapt better to the world around us, but to see how change occurs and the freedom that change confers. Group analytic therapy does not so much break with analysis as offer a different kind of analytic frame, one in which the goals, values and institutional factors of psychoanalysis are less unconscious and more starkly on display. As a result, it always risks being seen as a less sophisticated, more cultish and more anti-institutional form of analysis because it offers its own therapeutic wager: a negotiable, less costly, adaptable context. And yet, for all the outlandish and dubious incarnations that have been practised under its name, group analytic therapy continues to offer the practical resources for a vision that has yet to be realised – a psychoanalysis for the people.

This article was written with funding from the Leverhulme Trust.