Psychoanalytic Expressions:
A Journal of Art and Words.

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Who am I ?
Using Group Therapy to Modify and Foster Identifications
Steven Kuchuck, LCSW, NCPsyA., LP

Despite more recent developments in the field, Freud’s original description of identification still holds true. Others have added to or modified his description. Horner notes that one’s sense of self or identity continues to be modified throughout life by later identifications with other relatives, heroes and important objects (people).3 Identification, she feels, is particularly important in psychotherapy, where the attitudes and functions of the therapist are internalized and eventually utilized in the self-healing process. In group therapy, of course, a similar opportunity exists for multiple identifications.

Several authors have written about the process of identification in group psychotherapy. In 1973, Jeske hypothesized that the incidence of identification with other group members will be significantly higher for those who show a positive change in therapy, as opposed to members who show no positive change.4 This hypothesis was experimentally confirmed using MMPI pretests and posttests with a mixed (men and women) adult group. A positive correlation was found to exist between frequency of identification and improvement in therapy. Based on these results, Jeske recommends homogeneous grouping according to symptoms and problems, in order to provide more opportunities for identification. He also notes, however, that identification also took place with subjects whose problems were different from their own stated difficulties.

Kanter focuses on the group therapist’s role in fostering identifications. He feels that the group therapist in particular is in an influential position since he/she is a role model for multiple imitations, identifications and resulting identity formation.5 In carrying out this leadership role, it is important that the group therapist be able to manifest empathy by encouraging other members to express similar thoughts and feelings, thereby fostering the potential for identifications.

Yalom notes that identification with peers is an especially important aspect of group treatment.12 Patients acquire strategies for approaching various situations from each other and the therapist. Patients often begin to approach problems by either consciously or unconsciously considering what others in the group would think or do under the same circumstances. This initially imitative behavior, frequently initiated in order to gain group approval, will often lead to enhanced functioning and greater acceptance by others. One’s self concept and selfesteem may then be boosted. What was initially imitative now becomes a more internalized identification.

Yalom also notes that identification may be a particularly important aspect of group treatment for borderlin personality disordered patients or others who may find it difficult to form a therapeutic alliance with the therapist.12 For these individuals, group provides an opportunity to maintain a greater distance from the therapist while at the same time being able to observe and internalize aspects of the therapist’s behavior and therapeutic interactions with the patient and with other members.

In describing an adolescent girl’s group, Slavson writes that it is through group members’ identifications, especially with each other, that catharsis is often accelerated and intensified.11 The potential for identification, he feels, is one of the major advantages of group therapy. It is the awareness of similarity, Slavson continues, that helps group patients to see themselves more objectively and to be able to cope with their troubles. Additionally, identification increases what is often an initially limited capacity for object relations.

Saul Scheidlinger is one of the few authors who has written extensively on the role of identification in group psychotherapy. Scheidlinger identifies three main types of identifications that occur in groups: identification with peers, identification with the therapist and identification with the group as a whole.8, 9 The author believes that this last form of identification in particular leads to enhanced selfesteem and a clearer sense of identity. As Erikson notes, a healthy (ego) identity constitutes the end result of multiple healthy identifications.1 Identifying with the group as a whole can act as a bridge to mature object relations and to enhanced reality testing.

How Group “Cures”

If we think of identification as a process that first starts within the context of the family system, then it makes sense that the surrogate family experience of group therapy can be an arena in which to explore, alter and modify identifications. Leslie Rosenthal, in writing about group patients, notes that there are in fact some individuals who feel too frightened to engage in individual treatment, but can remain fairly comfortable on the periphery of a group while still benefiting from the catharsis and insight of other members.7 Rosenthal’s observation is useful in understanding this curative aspect of group, though for reasons beyond the scope of this article, my own belief is that group treatment should rarely if ever be conducted without concurrent individual psychotherapy. (The inverse is not necessarily true. For many patients in need of individual therapy, group treatment cannot be clinically justified). Rosenthal also notes that another category of patients for whom group can be particularly helpful is one comprised of those who feel the need to oppose authority. In group, their strong effort to defeat the therapist (parental transference figure) may be challenged not only by the therapist, but by the often more influential authority of their peers.As previously mentioned, group is usually experienced by patients as a supportive, surrogate family wherein the members can understand and validate each other. This is often in contrast to patient’s real families of origin or current families, and the new family experience of therapist as nurturing parent and members as supportive siblings can help the patient to form more benign, supportive identifications. Scheidlinger develops this idea further. He believes that group members identify with the therapist as a father (regardless of therapist’s gender), with each other as siblings and with the group as a whole as a mother.10 Although in part perhaps a somewhat outdated concept, the therapist is seen as a father in that he or she is a caring, nurturing parent figure other than mother — a representative of the world outside of mother. The concept of therapist as father represents a chance to help our group patients to neutralize the effects of often engulfing, sometimes sadistic parents and parental introjects and to therefore replace old, pathological identifications with more adaptive ones. Relating to group as a good mother — a nurturing, supportive, protective and need-gratifying entity — also serves similar functions. Scheidlinger further explains his concept of group as mother in terms of “The universal human need to belong, to establish a state of psychological unity with others” in order to “...restore an earlier state of unconflicted well-being inherent in the infant’s exclusive union with the mother to counteract a fundamental fear of abandonment and aloneness in all of us” (p. 420). It is in part this quest for belonging and psychological unity that makes group such a powerful modality for patients and one in which identifications and subsequent identity formation can occur.Additional ways in which groups allow old object relationships to get reworked and to therefore lead to new identifications include the opportunity patients have to verbally display sexual and aggressive drives in the therapist’s presence without retaliation or abandonment, as well as the chance for patients to reflect on their behavior and the role they play in provoking negative responses from family, partners or spouses and other systems. These processes are integral parts of not only the identification process, but are also intricately related to the restructuring of the patient’s ego ideal (sense of self and who he/she is, hopes to be and hopes to become).

Case Illustrations

Karl, 48, was originally self-referred for individual psychotherapy to address symptoms of depression and anxiety-difficulty sleeping, lack of pleasure in any of the activities that used to be enjoyable, obsessive thoughts and ruminating about unfinished tasks at work and home and guilt and discomfort about periodic bursts of anger directed at his wife and employees. He felt distant from his family and had very few friends. An only child raised by a verbally abusive, extremely controlling and sadistic father who could also be quite obsessive in his demands for neatness and perfection and a passive, dependent mother who was ineffectual as a protector from his father and under-nurturing and withdrawn due probably to her own depression and panic attacks, Karl remembers being frightened of his father’s temper and feeling somewhat isolated as a child. In treatment, Karl found that for the first time he could talk about what went on in childhood, and slowly he began to clarify for himself some of the impact these events had on his development. He was also able to begin to connect some of the earlier trauma with his current symptoms. Karl discovered that he had strongly identified with aspects of both of his parents, though especially with his father. He had even gone into the same line of work as his father and became a general contractor. Now he found himself troubled by a level of uncontrollable anger and obsessiveness all too reminiscent of his father. Of additional interest, though not surprising, was the fact that Karl’s symptoms seem to have worsened since his father’s recent death. This was, in fact, what finally motivated Karl to seek help. Freud said that a particular type of identification takes place when an object is lost, as in death, and one unconsciously models himself or herself on the lost object as an effort to hold on to the object.2 Although therapy was helping Karl to more clearly understand and articulate these issues, he was struggling to hold on to his early identifications and progress was limited. Other than the occasional outburst of anger, Karl had a difficult time accessing and articulating affect, and I suspected that the combination of his early, toxic identifications along with a tremendous amount of repressed anger, sadness and longing to connect were contributing to the treatment impasse.

Though anxious and somewhat reluctant at first, Karl eventually accepted my invitation to join a newly formed therapy group. Initially, like Rosenthal’s patients, Karl stood on the periphery of the group.7 Verbally, he participated minimally, but seemed fascinated by the other members‘ stories. He became vicariously excited as members gained the clarity and courage to communicate more directly and, when necessary, to confront spouses, family members and, as often needs to happen in groups, each other. This was particularly evident in his quiet admiration of Mary, a particularly verbal member of the group who was quick to anger and tears. Individual treatment sessions seemed to transform from black and white to color, as Karl discussed his feelings about the other group members — and, via identification with the others, the group as a whole — and, eventually, me (by taking on my curiosity about and interest in Karl’s and the other member’s thoughts and feelings — and becoming more curious himself) began to be more in touch with previously repressed affect, and a longing to connect — on a more emotional, intimate level with some of the other members of the group (many of whom, like Mary, were more able than Karl to articulate feelings). Through practice in the group, Karl learned to communicate more directly and intimately with his wife. At this point, new, healthier identifications have replaced earlier identifications, previously repressed affect has become more accessible and symptoms are beginning to lessen.

The group comments on how strange it feels without Leo and Sam. Alex asks Dan why he was absent last week and why he didn’t call to let us know that he wouldn’t be coming in. Charles said that he too was very angry with Dan for breaking this basic rule, and Alex said that he questioned Dan’s loyalty to the group. Alex also said that he’s angry with the absent members as well, and that they are not loyal and dedicated enough to be here today for our last session before vacation. This brings to mind Scheidlinger’s observation that one sign of a patient’s identification with the group as a whole is that he reacts to a criticism or slight of his group as if he himself had been offended.9 Alex said that this is all very depressing because it feels like the group is falling apart. He said that it feels like someone is dying and this leads to a discussion of all his relatives who have died — including his father. Alex discusses the beatings he watched his mother endure prior to the death of his father and how he wishes that he could have done something to protect her. He then brings up the issue of his name and says that it disgusts him to have the same name as his father (toxic identification). The group is silent for a time until Dan tells us that before his parent’s separation he too used to witness his father beating his mother and, like Alex, felt guilty about not being able to stop the beatings. Such mutuality of experience occurred often in the group, and it helped to foster identifications between members and with the group as a whole. These boys longed for healthy objects to identify with. Their longing showed in the younger or less sophisticated members’ idealization and frequent imitation of the older, more socially adept members. It surfaced in the group’s playful imitation of my words and gestures and in the members’ careful, almost ritualized scrutiny of my clothing. I encouraged this process of identification by supporting those members who made the effort to explain to the other members a complex social ritual such as dating, for example. I also answered personal questions when appropriate and when I felt that my answers would be utilized for purposes of identification.

 

 
Artwork "Who Am I" by Carol Marguet - courtesy of NARSAD

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