International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Group Psychotherapy and Changing Social Values Otto Pollak To cite this article: Otto Pollak (1976) Group Psychotherapy and Changing Social Values, International Journal of Group Psychotherapy, 26:4, 411-419, DOI: 10.1080/00207284.1976.11492274 To link to this article: https://doi.org/10.1080/00207284.1976.11492274
Published online: 29 Oct 2015.
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Group Psychotherapy and Changing Social Values
OTTO POLLAK, PH.D.
J
TIS ALWAYS CHALLENGING to write history for the future and it is not unprecedented. Usually, however , it is written in a mood of impending catastrophe. Perhaps, the best known-and, incidentally, correct - predictive work in this mood was The Decline of the West (Spengler l 926-28). Newer messages of prediction threaten us with the disappearance of the ozone shield in the atmosphere, political dependency on countries rich in raw materials, and/ or a tomic annihilation. It seems to me that few historians have ever had the courage to predict an improvement in the future with the confidence of Maca ulay (1854). Robert Waelder once told me that every level of comfort produces its own discomforts , and I believe that the reverse is also true. I should , therefore, like to take a middle position. I do not know whether life will be better or worse in the next few decades, but I see certain changes appearing with which psychiatrists, social workers, and probably also physicians, who are organically oriented, and nurses will have to cope . It seems to me that the way of life in our society is showing a trend of increasing
Dr. Pollak is Professor of Sociology , University of Pennsylvania ; Visiting Professor of Sociology at the Department of Psychi atry, Medi cal College of Pennsylvania ; and Visiting Professor a t th e Dep artm ent of Psychiatry and Huma n Behavior , Thomas Jefferson Medical College, Phila delphi a , Pa .
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impatience and of an increasing mechanization. In other words , we want to have quick change in our circumstances , and the people who are entrusted with helping us to experience such changes are increasingly trained to treat us as responding or not responding but , at any rate , nonquestioning recipients of the helping effort. The outstanding life style that I see developing is the search for intimacy in nontraditional places . Intimacy in the parent-child relationship is disappearing more and more because we entrust child development to institutional arrangements. Increasingly, from the day care center on, children really do not live at home during waking hours enough to establish intimacy with their parents or siblings . A search for intimacy is then being looked for potentially in peers , such as the arrangement of college students who live together before marriage. It is also often sought in therapeutic contacts . When that happens , therapy is saddled with a function that it really cannot fulfill if it wants to remain professional, namely , to give the warmth of the human experience and the reciprocity in revelation which we usually associate with the term of intimacy. Intimacy means exposure in the expectation of positive response, and the exposure must be reciprocal. If we permit somebody to become intimate with us , we permit him to see us exposed, and exposure usually does not reveal perfection. Emotional undressing is characteristically not the revealing of beauty but the revealing of defects , and one can engage in this only in the expectation that, because of relationship , the defect will not be taken as a stimulus to censure or as a point of attack but as a stimulus to love . If the individual starts looking for relationship with a physician, a nurse , or a social worker, he entertains an expectation that cannot be fulfilled . Therapy becomes disappointing , therefore . It may well be that only group therapy , and conceivably gestalt therapy , will make it possible to create therapeutic experiences which give reciprocity in intimacy. This can be so because the reciprocity that intimacy requires does not come from the professional; it comes from the other members of the therapeutic encounter, from other patients . From this point of view I think that group therapy may have a greater future than one-to-one therapy. Medical advances in instrumentation have made it possible to treat the human being without relationship. The denial of relation-
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ship may still produce anger but it need not interfere with treatment. When you are put under anesthesia and you have a surgeon who treats you like a piece of meat, he still may be an effective surgeon. You may leave the experience of having had surgery from this man or woman with some feeling of antagonism but the scar nevertheless heals, the tumor may have been fully excised, and you are helped. The competitive methodology of behavior modification represents a form of training which we used to confine to domestic animals. The therapists condition the patient to adaptive responses (Wolpe , 1958) , which implies, of course, that the patient is treated as a dependent variable, but if he feels better, he may be willing to experience this extreme type of inequality. The wish for equality, however, will remain and will present a client problem. It is one of the characteristics of our culture that people go to professional helpers but, by and large, are hostile to the helping profession. There is a tremendous ground swell of feeling against physicians and nurses, and some spillover also against social workers, who are called "do-gooders" as if doing good were something inappropriate or offensive. In health law projects, in the protection of human subjects in clinical research, there are indications that we are witnessing the beginnings ofrebelling against a health care system in which the patient is treated as an unequal but is not able to do without the treatment that denigrates him. I believe that this will become a very serious trend in the near future. Helping professionals who can see this movement of antagonism coming and can so change the therapeutic practice as to give relief or avoidance to the offense of helping, I think will be pioneers in the development of helping methodology in the decades to come . Another point which I would like to make is the probable disappearance of certain expressions of behavior which we designate now as pathology. Homosexuality and lesbianism are returning to social acceptance. This is not unprecedented; antiquity treated them so . I am sure that as living arrangements and life-sharing between people of the same sex are becoming more open and ideologically extolled as socially advanced, they will present new problems. We are a country dotted with marriage counselors whose function is treating people of different sex with difficulties in living together. I think we will have to study the difficulties of living together for two people of
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the same sex. There is no reason to assume that a lesbian marriage or a homosexual marriage will of necessity be happy . frictio nless , or not mutually harmful , as is sometimes expected in the utopian glow of social change (Kelly, 1972). Therapists may have to rethink the therapeutics of marriage in terms of two people of the same sex, which may be difficult because the people who engage in these arrangem en ts do so usually with the feeling of being very brave and ideologically advanced. It is not easy for them to say that they are leaders of a social movement but that they cannot stand one another or make one another anxious. At the moment we are tremendously concerned about drug abuse and about alcoholism. We do not believe that a decision to change one's state of consciousness is a normal expression of behavior. We must, however , realize that we all do this more or less , that every bathroom , at least in the majority of American houses , is a repository of supplies for drug abuse. It is only the question of degree or intensity which distinguishes the pathological drug users from the nonpathological. We are encouraged by our physicians to take sleeping pills if we are sleepless , we are supposed to take energizers if we are groggy in the morning from these sleeping pills, and we have an array of pain killers if we hurt. Ch ange of consciousness has become part of our life style , and the problem is to identify the point at which drug use becomes pathological. Perhaps more important is the question whether funct ioning in traditional ways need still be an overriding treatment goal. The methadone clinics represent this assumption , but they really substitute one addictive drug that does not prevent social functioning for another addictive drug that does. One might come to a therapeutic reorientation in which one would not consider social functioning as an essential of the human condition . Is it really the essence of the human condition to go to an office , cook a meal , sell merchandise , teach or study? I think this is a revolutionary question . Many of us may say that if all of us stopped functioning , the world would come to an end, but I do not see that risk . It may become desirable to help some families to live with a nonfunctioning member without feeling that something has to be done about it . It is a question of social tolerance for variants-and I am avoiding the term "deviants intentionally . Which variants are deviants is subject to changing definitions; deviance implies in its linguistic root that we strayed from the road . "Via " means the road and deviance means to
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get away from the road. In our society we seem to have come increasingly to believe that life is a delta where there are many roads , and that may have implications for identifying clients in the family of the variant rather than making the automatic assumption that the variant is the client. Another difficulty for future therapeutics may well be that we get many more disappointed people than we are expecting to see in a time when women and black people are gaining access to so many opportunities formerly closed to them . The disappointment will come , I think, largely from the sense of urgency generated by an irreligious life ; things must work out immediately because there is no transcendental compensation for failure . In the search for immediacy one is likely to accumulate disappointments, and disappointments drain the vitality. If people engage in a fruitless search for instantl y satisfying constellations, it seems to me that it will be very difficult to treat them in therapy. Whether it be psychotherapy, group work, or counseling in any form , how does one treat somebody who has failed in four marriages or somebody whose seven sons, one after the other, have had trouble with the police? It will be hard to give such a patien t hope in the initial contact. People who arrive hopelessly and frequently by assignment rather than by their own decision will need great interventive skill and probably long effort to see a glimmer of hope. Such people may come only long after they should have received' help. In the therapeutic professions one prefers to deal with a young person on the assumption that one can do more with the non-fully developed individual or with a young couple rather than with older people. But, because of the impact of the women's movement , it is probable that people will experience marital disappointment relatively late in life since many young women embarking upon professions will postpone marriage . I presume that they will get married but that when they do, they will not have the resiliency of young people and will have other claims already built into their lives. I am expec ting that therapists will see greater numbers of relatively exhausted patients - exhausted from living, disappointed in their expectations of life - and that this will require from therapists either lesser expec tations of patient cooperation or more patience in building up hope of improvement . Very m uch related to this is the tendency to assign more and more
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individuals to therapy , which is an interference with freedom that our defenders of civil liberties have been slow to identify. Of course we have always had a group of assigned patients which , out of the benevolence of our civilization, we have not fully recognized as being such : namely , children. Children are brought by their parents, OI they are forced by the school system into treatment. I understand now that they are even forced, if they are hyperactive , to take tranquilizers in certain schools or face suspension. We are increasingly assigning drug abusers and sex offenders to group therapy , and it may be only a question of time until judges assign people who appl y for divorce to group therapists . This is not unprecedented . Jewish orthodox marriage law grants divorce only after a rabbi has tried three attempts at reconciliation, and from there to prescribing a year of therapy before the divorce is granted is not such a long road to travel. An adult patient who does not come on his own initiative but is forced into therapy is a new type of patient who may see in the therapist somebody who is allied with forces against him. An assigned patient must experience a higher degree of resentment than follows simply from the experience of inferiority which results from the status difference between patient and professional helper . It is a new inferiority ; not only do you need help, you are told that you need help and something is being done about it. I think completely new therapeutic methods will have to be developed to prevent the office of the physician or the social worker from taking on the atmosphere of an "hour prison" to which the patient has been committed. In more general terms, it has always been noted that women seem to have more emotional problems than men. This has been identified by the women 's liberation movement as a result of oppression or sexism on the part of male therapists. Whether this is true or not , I would hazard that in the future the majority of patients making their appearance in clinics and doctors' offices and maybe in emergency rooms will be male. It is just as possible for males when they are helpless or feel hopeless or deprived to develop symptoms of mental disturbance as women do or did, and I think there will be a shift in the sex ratio of patien ts in the next twenty to thirty ye ars . This may ultimatel y even out, but in the period of transit ion in which we are now living , I have little doubt but that the number of males seeking relief from loneliness and depression will increase . Fear of abandonment will probably join the fear of impotence as a major
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concern as a result of desertion by mothers or wives. The deserted male will suffer not only damage to his self-image, but such feelings of loneliness and failure that therapeutic intervention will be required. The tenacious misconception that therapy can and will bring happiness seems to be producing disenchantment with established therapeutic procedures. Every year one hears about a new and specific therapeutic procedure that hasn't been tried before, and there is a constant turmoil of competitiveness among new methods. Formerly one did individual psychotherapy; then one added group therapy, so that Hyman Spotnitz (1961) could write a book called The Couch and the Circle. Now we have gestalt therapy, so that one would have to write "The Couch, The Circle, and the Hot Seat." Add encounter groups (Burton, 1970) and behavior modification (Levis, 1970) and one gets the feeling of a jungle of therapies, and in the jungle it is difficult to know which way to turn. I can envision a climate in which one must abandon talking or writing or practicing one's own methodology and instead engage in a confrontation with other therapies which the customer can watch and discuss. Another phenomenon that I would like to mention is that certain parts of an individual's life are becoming increasingly public. Birth, for instance, is more and more a public procedure. Not only is the father invited into the delivery room, there are advanced groups where community members and friends are invited to assist or at least be present at the delivery. On the other hand, old people are permitted to die in almost complete, though involuntary privacy. While I do not believe that infants upon arrival need a large company, I do have the feeling that in the agony of dying, loneliness is an additional difficulty. Nobody invites the neighbors to the agony of dying; even husbands and wives are sent away, and curtains are drawn around the bed of the dying in hospital wards so that even the presence of other people in the ward is shut out. I would suggest that probably the public nature of the beginning of life is overdone and the private nature of the ending of life very damaging. That group psychotherapy with the terminally ill in hospitals may break this loneliness may be wishful thinking on my part, but it is likely that it will become more frequently practiced as a result of increasing interest in the therapeutic care of the dying. Before closing, I would like to make one more point, particularly as it concerns young people. Young people in our time have grown up
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in a perm1ss1ve society. The convergence of Dewey's educational philosophy and psychoanalytic understanding about child development, supported by our general democratic ideology , have created in the United States a type of child-rearing and an educational system which does not prepare young people for the nonpermissiveness of adulthood . I think most young people experience an incredible shock at encountering reactions from the world which they have not been led to expect. At first, the reality is blurred by the Anglo-Saxon courtesy in which we cloak disapproval, but between twenty and twenty-five or twenty-seven, young people discover that courtesy is courtesy only and not permissiveness, and their self-image may be damaged when they are not hired or promoted, although everybody was so kind to them when hiring or promotion was discussed. I do not propose that the therapeutic professions have a mandate to change the world. Permissive childrearing unfortunately is more comfortable for parents because they do not have to make many decisions as a child-rearer. It is much easier to be permissive than to be nonpermissive , but then somebody has to help the young individual who faces confrontation with a nonpermissive world . Ultimately all employment, all movement through complex organi zations is nonpermissive. I have a suspicion that marriage also is a non permissive proposition and that a lot of the troub le we experience as spouses comes from a life course that does not prepare us for this encounter. Even the antagonism of a patient to a hospital may be partly due to the fact that suddenly he encounters a nonpermissive world , as in such a common complaint as: "The nurse woke me up because she wanted me to wash." Patients have to be washed , menus have to be signed if cleanliness is to be preserved , if the meal is to come from the hospital kitchen. If you waited for every patient to act in his own good time , how could anything get accomplished ? And that may be one more need for the helping professions, namely, to help people who have been brought up permissively in their encounter with a non -permissive world. REFERENCES Burton , A. (1970), Encounter. San Francisco : Jossey·Bass. Kelly, J. ( 1972 ), Sister Love : An Exploration of the Need for Homosexual Experience. Famzly Coordinator, 21:4n-475.
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Levis , D. J. (ed.) (1970), L earning Approaches to Th erapeutic B ehavior Change. Chicago: Aldine Publishing Co. Macaulay, T. B. (1854), Speeches. London: Longman , Brown, Green and Longmans. Spengler, 0. (1926-28), The Decline of the W est. Translated by C. F. Atkinson . New York: Kn opf. Spotnitz, H. (1961) , Th e Couch and the Circle. New York: Knopf. Wolpe, J. (I 058), Psychotherapy by R eczprocal Inhz"bition. Stanford, Calif.: Stanford University Press.
Dr. Pollak 's address: Dept. of Sociology University of Pennsylvania 3718 Locust St. Philadelphia, Pa. 19174