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President-Elect’s Column: International loneliness, Population Health and Group Work

Martyn Whittingham, Ph.D.
Martyn Whittingham, Ph.D.

In recent months, I have been fortunate to have spent considerable time traveling across the country and internationally, delivering workshops and working with therapists hungry to improve their group skills. In these travels, I have discussed with these therapists how they see overlap between culture, interpersonal relationships and identity in their setting, region or country.  As I have been teaching, I wanted to make sure that any underlying principles, techniques and assumptions were always held in check to allow local therapists and systems to engage in rigorous questioning of when to adapt and when to adopt a model of working.  Listening to them talk about their local issues has been fascinating and illuminating.  Chinese therapists discussed the implications of a massive shift in their culture toward service industries and how this has increased stress on their population, leading to increased mental health problems.  The government in England, my home country, has created a Minister of Loneliness to address serious national mental health problems that have been identified. America is struggling with issues of identity, culture and politics, with issues becoming increasingly polarized, leading to significant schisms in society.

Shifts within and between cultures create considerable stress on societies and individuals in those societies are constantly adjusting to meet them.  However, we are at a point in history where these shifts are occurring so rapidly that our ability to meet them is stretched to the limit.

Social support is a major stress buffer to these forces.  They can support our identity, help us manage stress, help us to emotionally regulate and can offset the need to engage in more self-destructive behaviors. Moreover, the impact of a lack of social support impacts more than just mental health. There have also been multiple articles and news reports recently, pointing out the research showing that loneliness can lead not only to mental health issues but also problems with physical health such as increased likelihood of heart conditions, diabetes, increased risk for dementia and overall mortality.

The problem has been identified.  People are not able to generate the social support they need, and this is impacting not only mental health but physical health as well.  The impact on people at the individual, micro level is obvious to therapists, as we see it every day in our offices.  However, the societal, macro level impact of loneliness and lack of social support is now beginning to be identified by societies and their governments.  This represents a major shift in thinking and a significant opportunity for group therapy to utilize its strengths.

The idea of what constitutes a group therapy has never been more germane.  There are many types of groups that are essentially individual therapy in a group. They focus on individual techniques and strategies and can be enormously helpful. However, as I have travelled I have become even more convinced that group as a treatment modality, and not a delivery mechanism for other therapies, has a very significant role to play in helping world population health.  Group has inherent power in helping people connect with others.  Understanding and working on attachment styles, interpersonal inflexibilities, social skills, cultural identity, cross-cultural dialogue, and simply learning to bond and connect with other human beings, has a healing power that operates at many levels.  It has lasting impact on the physical and mental health of both individuals and whole societies.  It is time for group work to claim its place in the field not just of mental health but of global population health and to begin to assert its true worth.

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Columns Leadership Welcome

President’s Column: Irvin Yalom and the Fiction in Stories of Group Therapy

Giorgio A. Tasca, Ph.D.
Giorgio A. Tasca, Ph.D.

At this year’s APA convention I will have the honour to introduce Irvin Yalom at a special conversation hour on Thursday August 9 at 11am. Dr. Yalom will receive an award from our Division celebrating his lifetime of work as it pertains to group psychotherapy, and acknowledging the great influence he has had on the field of study and practice. My first initiation to Yalom’s writings was as an intern back in the 20th century. I was given his book The Theory and Practice of Group Psychotherapy (3rd edition), and told to read it by my supervisor because I was to participate in an inpatient group with her the next morning. Well, for those of you who know The Book, it’s not a volume that one reads in a day, rather one studies it over many days/weeks/months/years. Nevertheless, I gamely pored over it, understanding some but not much of the content. All I remember from the next day’s group was that most of what happened went over my head, and that my supervisor seemed to know what she was doing, though I didn’t know why. Maybe that is why it felt that the post-group discussions that day (and others in which I’ve participated over the years) seemed like fiction to me – that is, narratives constructed by therapists to make sense of what had occurred. I wonder if that is why Irvin Yalom turned to fiction particularly later in his career when trying to bring to life the complexity and mystery of what occurs in human interactions and group psychotherapy in particular. In Every Day Gets a Little Closer, Yalom told a true (?) story of treating a young writer, Ginny, who had writer’s block and limited funds to pay for treatment. They struck a deal in which Yalom and Ginny wrote parallel journals of each therapy session. Sure, there were some similarities in what they wrote, but there were also striking disparities that showed how widely two people can diverge in their narratives of the same events. Was this two people simply telling their versions of what occurred or was this fiction? What happens when you put 8 people together in a group – do we get 8 versions of events? Recently, a member of one of my groups, Jim, retold a distressing incident that occurred several weeks ago, but this time he described the event with considerably less distress and even flippantly. Another group member piped up and said: “that’s not how you described it last time!” What ensued was one of those discussions in group therapy about who said what, that as an intern I would have found pointless. Except it’s not pointless. People construct narratives (fictions?), and the narratives say something about who we are and how and what we need to do to manage. And just as importantly, the construction of the narratives tells us something about the nature of the relationships we are in when recounting the story. Jim needed to retell the story to his self and to the group differently this time, and to some extent this said something about his relationship to the group. In his novel When Nietzsche Wept, Yalom writes in part about the start of modern psychotherapy through a fictional encounter between Friedrich Nietzsche and Joseph Breuer. Psychotherapy, or psychoanalysis, likely had its start with Studies in Hysteria by Breuer and Freud – including the Case of Anna O. So, why did Yalom write of a fictional encounter between two historical figures to describe the birth of “the talking cure”, when perfectly good case studies written by the founders already existed? Was Yalom’s fiction more compelling or instructive than Breuer and Freud’s truth (can one even say that Studies in Hysteria was the truth)? Similarly, what I wrote in a few lines about Jim and my group was a distillation of a 90-minute session and a longer history of relationships between group members – how “true” can that be? (Should we go down that rabbit hole?). Irvin Yalom has had an important impact on my work and on my outlook on what I do as a group psychotherapist and group researcher. Some of that impact has come from his scholarly work (especially The Theory and Practice of Group Psychotherapy), but his fiction and his “non-fiction” has had an equal impact. I will try not to gush when introducing him on August 9th, but I may not be able to help myself – and that’s the truth, I think.