No doubt you are wondering about this confessional opening; it is to warn you that I may be over-reacting to some deceptiveness in an otherwise interesting article by Serge and Anne Ginger. I will get my sulk out of the way immediately and then go on to further observations. To begin with, the title of the article is "Gestalt Therapy Groups:Why?". To me this suggests Gestalt Group Therapy as one (most, we) generally thinks of it. However this article is not at all about your typical course of group therapy [Gestalt or otherwise], which usually consists of a session once a week for one and one-half to two hours. I have informally surveyed a dozen or so therapists (mostly Gestalt) in my neighborhood and to a person that is what they all think of when they think of ongoing group therapy. Perhaps it is different in France or Europe. In any case, the group therapy that the Gingers refer to in their article is another horse: namely once every two months for two to four days. This is a very interesting and provocative model, and I think the title of the article should have unequivocally reflected that.
Toward the end of the article, where they pursue the "Why?" part of their title, the authors state "The combination of group therapy (including regular emotional and physical implication) and individual therapy (more verbal) with the same therapist allows, in practice, to significantly reduce the length of the therapy" [italics theirs]. They go on to report a longitudinal study they made (Ginger, 1987) on 200 clients "with common existential problems" [italics theirs]. The study reports that "Significant, even spectacular improvement was seen" in two-thirds of the clients who participated in their program: six bimonthly group weekends per year combined with weekly individual therapy by one of the two group therapists (the groups are all co-led). They further compute that during this year each client had 100 hours of group therapy and 40 hours of individual, for a total of 140 hours. They then conclude "These results are comparable to those we have seen after 2 or 3 years of individual therapy" [italics theirs, underlining mine]. Now I am not a sophisticated researcher, yet I see at least one, maybe two bright red flags here. If the average client is seen for forty hours per year in individual therapy, then two years equals 80 hours and three years, 120. In either case that's fewer hours than the 140 in their program above. So what's suggested here is not that the length of therapy is reduced, but that 120 hours of therapy gets the same results as 120 hours of therapy, however it is distributed. Perhaps three times a week of individual therapy for one year (120 hours) would get the same results as their program. We don't know that. Furthermore, as far as I can tell, the whole research lacks any meaningful control group. A more sophisticated research person is needed here, yet that's the way it looks to me. I am suspicious of the "we have seen" a few lines above. It appears that these outcome measures were purely subjective, and of course made by the interested parties. The best we can say is that their program has interesting possibilities. And I want to end this section of the review by making clear that I am not accusing the Gingers of lying; if there is deception, it includes self-deception, quite understandable considering the enormous amount of energy they must put into their weekend program. And as one who has led numerous marathons, I applaud them for that.
All that said, here is a summary of their article: they describe their way of working, the setting, the conditions, some innovative techniques, their overall therapeutic style in the extended groups, a rationale for the use of Gestalt groups, a discussion of the cotherapist factor and finally make a case for their "cocktail" approach, that is the mix of extended bimonthly groups with ongoing individual therapy. I found the article a mix: mostly valid and interesting ideas and a few wacky ones.
To begin with, they are in the tradition of Fritz Perls - with a variation. Whereas Fritz in his "Group v. Individual Therapy" (1967) made a case for dispensing with individual therapy altogether, their case is for a combination of the two with group therapy having a special place in the armamentarium because "all kinds of problems can be worked on in a group situation, whereas many cannot be efficiently treated in an indivuidual therapy setting" [italics theirs]. They base this claim on the fact that the group setting allows for more bodywork and more of a social laboratory. Although this is true, I think it is probably also true that some problems are worked with more effectively in individual than group.
Their setting for the frequent weekend workshops is away from the city ("in the country") and is residential. This of course is quite demanding on clients' time, money and energy and provides a tribute to the Gingers that they can inspire such dedication. The authors describe many of their approaches and rules for their groups. Some seem innovative and useful to me (such as the "crystal ball" they use when there are newcomers: old members guess about the be person. "She's a nun";or "You own a dog"; or "You like tapestries" etc. According to the authors, these intuitions are astonishingly accurate; then they ruin it by attributing this to "direct communication between the unconscious minds".)
I found some of their rules very rigid, and, certainly, they wouldn't fit me as a leader. For example, participants may not broach another person's work to her/him in the group or out lest the latter feel "branded for ever, followed around by his problem". I don't get that.
The discussion of the work itself rang solid if familiar, and at times obvious to the point of banality; the same for the section on cotherapy and the one on the benefits of group (experimentation, opportunity for psychodrama, group support) and the one on the benefits of individual (simpler, safer, more controllable). The authors go pretty far out on a limbic limb by claiming their work promotes "physiological imprinting in the deep neuronal circuits of the limbic brain". Whether that is true or not, certainly their approach - their cocktail of frequent weekend extended groups combined with weekly individual therapy - is a powerful drink.
SUMMARY: Serge and Anne Ginger have written an interesting article on their dedicated use of frequent extended group therapy. Their approach has some generalization to typical group therapy, although their conclusions about its exceptional effectiveness are based on shaky rationale. I think they could do a better service to the community by writing about their extended approach in a more focused manner. For instance, what is it like for a group member to dedicate two to four days every other month to an ongoing residential group with the same people away from home? What is the impact of this residential approach? What does this add to the "hours" tallied up, for I imagine a good deal of growth and experimentation takes place between sessions as well as during them? Perhaps they could inspire more people to try this approach, keeping in mind the tremendous commitment it requires of both therapists and group members.
REFERENCES
- Ginger, S. and A. (1987) La Gestalt une therape du contact. Hommes et Groupes, Paris, 5 edition: 1994
- Perls, F. (1967) Group v. Individual Therapy. Etc. A Review of General Semantics, 24, 306-312.
