Genesis and Development of Group-Analytic Therapy in Great Britain: Bion, Bowlby, Foulkes, and the Relevance of Group Attachment

Abstract

A succinct account of the genesis and development of the Tavistock and group-analytic models of group psychotherapy focuses on their creators, Bion and Foulkes, and on how their life circumstances and their interpersonal and group attachment histories shaped their thinking and perception of the group and its therapeutic potential. The methodology combines historical investigation and literature review with psychodynamic and group-analytic formulations; it also provides an attachment-based, critical analysis of both approaches, their similarities and differences, and their mutual influence. Likewise, the chapter investigates the evolution of the concept of group attachment, formulated by Bowlby in 1969, which has been largely overlooked in the specialist literature until the last two decades, despite the fact that group lives, as well as interpersonal and group attachment, have played a fundamental role in our survival as a species and in our well-being and healthy development as a person. The present research is also informed by anthropological, psychosocial, organisational, and cultural aspects of human growth. It concludes that group attachment is highly relevant to group psychotherapy and that studying its nature and therapeutic implications should be an integral part of the training of psychotherapists and other mental health professionals, particularly those working with groups.

1. Introduction

Groups are at the core of human existence and survival; for millions of years, they have been fundamental for healthy development and have contained healing properties. Today, optimally, we may define group psychotherapy as a democratic, cost-effective, and inclusive form of psychosocial treatment.

In fact, from the outset, group therapy has been strongly connected to survival, both physical and emotional. It is widely accepted that this treatment modality was pioneered by the American medical doctor Joseph Pratt in 1905, as he decided to put together a number of patients with pulmonary tuberculosis in Greater Boston: there was a life-threatening illness to fight.

These patients were segregated from the community, in a way similar to the many forms of discrimination and marginalisation inflicted upon patients suffering from serious mental illness.

Pratt actually thought that, for his patients, sharing the knowledge of their illness and their coping strategies would not only provide them with much-needed emotional support, but would also help them maximise their chances of survival.

Indeed, these group therapy sessions were complemented with a psychoeducational component, largely delivered by Pratt himself [1]. This combined approach raised an important issue about how to integrate harmoniously the authority of the leader with the authority of the group.

Interestingly, Pratt was not a psychiatrist or mental health professional, but an internist. Somehow, this speaks in favour of the universality and healing potential of group processes, as well as the fact that mind and body are inextricably linked.

Some of the techniques used at the time can still be found in a range of group therapeutic interventions today, particularly in homogeneous groups, in which all patients have a common condition.

In Great Britain, the birth of group psychotherapy had its own specific intensity and purpose, in the context of the Second World War. There was an overwhelming and urgent problem to solve: having to fight and survive the war. That was, undeniably, a group effort.

At a psychological and political level, and in different ways, the task of developing group therapy was greatly facilitated by the work and ideas of three leading figures: Wilfred Bion, SH Foulkes, and John Bowlby, as we will see throughout this chapter.

In 1952, the Group Analytic Society International (GASI) was created and, in 1971, the Institute of Group Analysis (IGA) started national training programmes, based in London.

From its inception, IGA (a member of the European Group-Analytic Training Network) has offered a comprehensive training in adult group psychotherapy. In order to qualify as an IGA group analyst, current requirements include a one-year introductory course, followed by a one-year diploma course and a three-year qualifying course.

Apart from the training requirements of attending academic seminars, writing clinical and theoretical dissertations, and receiving their own personal group therapy, trainees have to conduct on their own (under supervision) a heterogeneous and slow-open mixed group with adults who are strangers to each other. In addition, they must conduct a special interest group, which can be homogeneous and might involve children, adolescents, adults or older adults.

Malcolm Pines [2], a founding member of both GASI and IGA, suggested that, in therapy groups as well as in other group configurations, members (including the therapist, conductor, or leader) share a common space: the powerful universal symbol of the circle, which has been a setting for the development of human relatedness through our evolution as a species.

Certainly, we can imagine our distant ancestors sitting in a circle around a comforting fire, after a long day, sharing true stories and fantasies, forming a natural (therapeutic) group and growing in their group belonging or affiliation and, also, in their group attachment, a more than useful concept outlined by Bowlby [3], the father of attachment theory. We shall elaborate on this later.

Mark Ettin [4], the inaugural recipient of the American Group Psychotherapy Foundation’s award for excellence, also referred to the healing properties of the group circle, about which he described a number of poetic metaphors. He pointed out that, in some religious traditions, circular motion has symbolised the sweeping, spinning, and stirring process of creation.

Furthermore, in some primitive communities, dancing a round (along a circle) was thought to animate the still forces of nature. Roundness became a sacred shape and evolved into a universal symbol of wholeness, a major goal in human developmental processes across the life course [5].

Likewise, the circle was associated with other healing properties, such as its inherent potential for mixing, arranging, and enveloping disordered and polarised multiplicities. The early psychoanalyst Carl Jung [6] suggested that, in a circular configuration, pointed edges can be smooth, relationships circumscribed, splits conjoint and chaos contained.

Other authors [7, 8] likened the group to the good-enough environmental mother, and equated the group’s reliable felt presence with an internally held comforting mother image: an archetype representing the holder of life.

In the following sections of this chapter, we will explore the genesis and development of the two main methods of group psychotherapy in Great Britain, which were pioneered by Bion and Foulkes. They created two distinct approaches, respectively: the Tavistock model and the group-analytic model.

Moreover, in this study, we shall describe and critically compare both approaches from our first-hand perspective, having trained in both institutions: the Tavistock Clinic and the IGA. In addition, we will explore Bowlby’s group mind, as well as core tenets of his attachment theory (such as the concept of group attachment) and his contribution to the field of group therapy.

2. Historical context to group therapy in Britain. Part I: the Tavistock model

Prior to the Second World War, in the UK and in other European countries, group psychotherapy was viewed by many members of the mental health community with a variety of negative feelings, which ranged from doubt to suspicion to contemptuous rejection. The primacy of the one-to-one therapeutic relationship and the analysis of the so-called transference neurosis were seen as central elements in any form of psychodynamic psychotherapy [1].

After the war, the use of the group as a method of treatment flourished in its own right, despite early hostile attitudes. There were many reasons for this. For example, in the context of war calamity and its aftermath, the group approach made it possible for more people to be treated by the same number of therapists.

And group psychotherapy gradually came to be a highly cost-effective and beneficial form of treatment for many different conditions in a wide range of settings [5].

In 1946, Wilfred Bion (1897–1979) was put in charge of group psychotherapy at the Tavistock Clinic, in London. Like most of his colleagues over there, he qualified as a psychoanalyst in the post-war years and was strongly influenced by Melanie Klein.

Bion had a charismatic personality, despite having experienced a difficult interpersonal attachment and group attachment history. His parents (to whom he felt insecurely attached) sent him to England for his education as a young child, whilst they remained in India contributing to the might of the British Empire at its pick.

After the separation from his parents, he missed home, struggled at a very strict boarding English school, sustained a serious physical injury whilst playing rugby and, later, went through severely traumatising experiences during the First World War [5].

At the age of just under 18, Bion joined the British Royal Tank Regiment. He became a Brigade Major at 19 and was sent to France where he was on active service until the end of the war. It seems that his military experience and reputation played an important part in the development of his charismatic thinking, and in the perception that other people had of him during his later professional career.

In those early days, more often than not, tanks were death traps from which only few survived. The following episode, whilst Bion was in charge of a group of tanks, became legendary. The day before one of the battles, he objected to the order of an attack in daylight, because he considered it would be suicidal. He suggested to attack either at dawn or dusk, with the cover of some mist.

This occurred at a time when higher commands new little about the handling of tanks. Following Bion’s objection, the divisional commander responded firmly, as reported by Trist [9]:

Wilfred, you may be one of my best officers but you are a boy. You may know more about these new machines than I do but you know less about battles. We will attack at 10 o’clock.

Bion rose again and said:

Sir, as I am a soldier, I obey orders and will attack at 10 o’clock, but as a staff officer I have the right to have my technical advice recorded in writing in the minutes of this meeting. You neglect it at your peril.

The following day, the tanks were wiped out; only Bion came back. In The Long Week-End [10], there is a moving autobiographical description of the fear and trauma of battle, looking back to that tragedy. He went further than that and actually wrote that his life concluded then.

We can imagine the deep sense of trauma Bion might have gone through, as he struggled to recover from the horror of the carnage of his companions, whilst he was also trying to make sense of his own survival. Interestingly, in his later professional life, he conceived a good therapist as one who has developed a capacity to think under fire. Surely, this conception relates both metaphorically and literally to the above war experiences.

It should be noted that the Tavistock Clinic opened in 1920, largely in connection with the need to provide psychological support to members of a society deeply traumatised by the First World War. However, at the time, the institution only offered individual psychotherapy.

Some 25 years later, when the Second World War had ended, there was an exponential increase of patient referrals. This pushed the Tavistock Clinic’s management to develop therapeutic methods that would help the institution meet such an overwhelming demand.

With the arrival of the National Health Service (NHS) in 1948, the Clinic was under pressure to maintain a patient-load sufficiently large, as to satisfy the new NHS authorities that out-patient psychotherapy would be helpful and cost-effective [11].

In fact, by the time the Clinic entered the NHS, many of the senior staff were already running patients groups under Bion’s headship. He also conducted groups for industrial managers and professionals from the educational world. In order to attract patients for the therapy groups, he offered two options: to wait 1 year for individual treatment or to start group treatment immediately [12].

In the early years, the strategy worked and there was strength in numbers. Bion was very enthusiastic about injecting his group ideas into the Tavistock’s post-war culture. Neurosis started to be perceived as a problem of personal relationships and, therefore, it had to be treated as a group phenomenon rather than as a purely individual one [13, 14].

Some of the Clinic’s new staff accepted that group psychotherapy was a most timely development, at a key moment when war survivors needed to learn how to help one another. Bion based his group therapy programme on his conception of man as a political animal, as he put it:

… an animal whose fulfilment can only approach completeness in a group. (Bion, in [11], p. 144)

However, there were difficulties getting in the way. Henry Dicks further pointed out that the newly-elected Tavistock’s professional committee knew pretty well what the views of most colleagues on the old staff were:

… disapproval of group therapy; there was difficulty in understanding that a community view of psychiatric disorders did not imply disrespect for the sanctity of the individual therapeutic relationship. ([11], p. 154)

Despite being a hugely influential and captivating figure, Bion gradually started to lose control of the situation. Perhaps he employed too radical an approach, as he seemed to be treating only the group as-a-whole, as if it were a single individual, rather than treating the individual group members. Many patients deserted or dropped out of group treatment.

Bion, who presented himself as the only source of authority in his therapy groups, might have been disappointed with the therapeutic results or unhappy with the sceptical culture towards groups within the institution, or both.

In any case, by 1952, he gave up and stopped running groups for patients at the Clinic or elsewhere [9]. However, he delegated his leadership of the Tavistock’s group therapy programme to Henry Ezriel and Jock Sutherland, who thoroughly described the application of Bion’s ideas as a method of psychoanalytic group therapy.

Ezriel [15, 16, 17] and Sutherland [18] favoured a technique whereby nothing but rigorous group-as-a-whole, here-and-now transference interpretations need be used. Ezriel particularly considered that these interpretations had to be delivered in the same manner as in individual psychoanalytic sessions. In this approach, the group became a quasi-individual.

For several decades, the overall mood in the institution was that therapy groups did not work. In the mid-1970s, David Malan led a comprehensive piece of research: 42 randomly selected patients were interviewed 2–14 years after termination of psychoanalytic group therapy at the Tavistock Clinic. The findings were staggering [19]:

Comparison of psychodynamic changes in patients who stayed less than 6 months with those who stayed more than 2 years gave a null result. The majority of patients were highly dissatisfied with their group experiences. However, there was a strong positive correlation between favourable outcome and previous individual psychotherapy.

These results cast doubts on the appropriateness of transferring to group treatment the strictly individual psychoanalytic approach, and critically pointed at the stringent approach employed by Bion and his followers. By the late 1970s, there was a sharp decline (almost extinction) of group psychotherapy at the Tavistock Clinic.

However, with some modifications, the Tavistock model was beginning to pick up at the time we started our training at the Tavistock Clinic, in the mid-1980s.

This revival owes a great deal to the work of Sandy Bourne, who allowed for his group therapy sessions to be observed behind a one-way screen (followed by clinical discussions) as a learning method, and to Caroline Garland [20], who had recently completed her group-analytic training at the IGA (next door) and brought a newly found sense of enthusiasm and creativity to the Tavistock.

Both Bourne and Garland played a large part in the process of re-engaging the institution with a revised, more user-friendly, evidence-based, methodologically stronger, and more effective philosophy of psychoanalytic group therapy.

3. Historical context to group therapy in Britain. Part II: the group-analytic model

In contrast to the Bionian or Tavistock model, SH Foulkes (1898–1976), a German-born psychiatrist and psychoanalyst who came to England as a refugee, paid specific attention to the individual needs of his group patients, whilst keeping in mind the group as-a-whole and claiming that, ultimately, the individual is an abstraction and cannot exist outside a group.

Foulkes [21, 22, 23, 24] developed the group-analytic approach, in which the therapist or conductor usually provides security and immunity for as long as the group is in need of them. Like Bion [10, 13, 25], he also conceived man as a social animal whose fulfilment can only achieve completeness in a group.

However, Foulkes’s therapeutic attitude comprised more distinct holding and containing qualities, towards both the group itself and the different individuals within it. For this, he took into account other levels of group life, such as its intrinsic sociability, together with conscious and unconscious understandings that people in the group-analytic matrix demonstrate to each other. He believed in the inner-authority of his patients.

Whilst Bion was largely influenced by Melanie Klein, Foulkes’s primary influence was Sigmund Freud [26], who himself had concluded that the psychology of the group is the oldest human psychology. This theoretical contrast between Bion and Foulkes was amplified by the differences in their real-life experiences.

Foulkes had a more benign interpersonal attachment and group attachment history than that of Bion. He was brought up in the prosperous city of Karlsruhe, in a liberal and middle-class Jewish family. He experienced sufficiently secure attachments with both his parents; he was a popular boy at school, and thoroughly enjoyed playing football and tennis [27].

At the age of 18, Foulkes was enlisted in the telephone and telegraph section of the German Army, during the First World War. He served in France in the rear, where he discovered the power of communication for maximising survival. This idea would become one of the cornerstones of his conception of group psychotherapy [28, 29].

After the war, Foulkes undertook his psychiatric training in Berlin and his psychoanalytic training in Vienna. But his career and his family life were disrupted by the Nazi danger. Together with Erna (his first wife) and their three children, he had to run away from Germany to the relative safety of the UK, in order to evade an order that Hitler dictated in 1933 for him to surrender his passport.

Upon his arrival in London, he changed his German-Jewish name (Siegmund Heinrich Fuchs) to a phonetically British one, in order to disguise his identity of origin and, thus, maximise his chances of survival. Officially, he became SH Foulkes. In addition, he asked his family and friends not to use his first or middle name, but to call him Michael [30].

With the outbreak of war, London was no longer a safe place and Foulkes moved to the provincial town of Exeter, where he led his first therapy group in 1940. This group was made up of a number of patients he was treating individually. He felt curious about what they may have to say to each other if they were put together as a group. Indeed, he was experimenting, as Pratt had done some three decades earlier. And he also did it with a safety net.

In the group, Foulkes [22] listened to the conversations of his patients with a technique that he would later describe as free-floating attention, a kind of equivalent to the free association of the individual psychoanalytic method.

He also paid attention and tried to be sensitive to how the words were expressed and connected to one another (or otherwise), including the tone and modulation of the voice and the non-verbal language. That was the birth of what is known today as group-analytic psychotherapy.

Generally speaking, Foulkes [23] conceived his therapeutic role as that of a conductor and facilitator of communication and understanding amongst group members. In fact, he emphasised that the most important factor in group therapy is the process of communication itself, rather than the mere information that is transmitted.

Over time, perhaps influenced by his work as a communicator during the First World War, his views became quite radical, suggesting that psychotherapy is about keeping the communication process alive. Therefore, in his mind, psychotherapy and communication came to be the very same thing.

There was another important background to the evolution of his ideas. In 1943, Foulkes was called up as a British Army medical officer to replace Wilfred Bion and John Rickman, who had jointly led a therapeutic project called the First Northfield Experiment. Northfield was a military psychiatric hospital near Birmingham, in the heart of England.

This hospital had been reorganised with a view to helping the Army identify which soldiers had the possibility of making a recovery from their mental problems, in order to return to the front lines, and who should be discharged as unrecoverable.

The usual diagnosis used at that time was shell shock or war neurosis; what is now called post-traumatic stress disorder had not yet been clearly conceptualised.

Bion and Rickman [14] had introduced a radical treatment regimen. Neurosis was seen as the enemy; soldiers had to learn to face such an enemy and develop the courage to pick up their rifles again.

It would appear that Bion and Rickman tried very hard to get sick soldiers back on active duty as quickly as possible, perhaps without fully addressing their mental health problems. Since the war context had generated highly dangerous and critical situations, from their point of view, the survival of the group and that of the nation had priority over the survival of the individual.

For reasons not entirely clear, this first group therapy project crashed before taking off. The military authorities, puzzled by the disturbance caused within the hospital environment, decided to close it down after only 6 weeks [5].

We have the impression that Bion and Rickman failed to anticipate the tremendous impact of their drastic measures, not only on the sick soldiers but also on the therapeutic community they were trying to create. However, they laid key theoretical foundations, which turned out to be seminal for the study of group dynamics, both in therapeutic and institutional contexts across the world [13, 25].

Soon after Bion and Rickman left, Foulkes set up a new programme, called the Second Northfield Experiment. He incorporated some of the notions of his predecessors, but used group psychotherapy more specifically for the emotional well-being of soldiers than as a tool for returning them to the battlefields to face death.

His attitude was so benign that he often began a group therapy session with the following remark:

As long as we are in this psychotherapy group, we are not in the Army. (Foulkes, cited in [27], p. 203)

Although Northfield’s two experiments differed in pace, technique, and effectiveness, they both shared many underlying concepts, such as social responsibility and the therapeutic use of the environment or milieu. In other words, both Bion and Foulkes perceived the hospital as-a-whole and tried to develop its healing potential as a therapeutic community [2].

Despite his doubts and hesitations, Foulkes made Northfield’s second experiment a success. From 1943 to 1945, he treated vast numbers of soldiers, all in groups, as psychiatric casualties in the Army came to increase on a massive scale. With care and patience, Foulkes designed an innovative and powerful psychotherapeutic tool [27].

Although he drew heavily on psychoanalytic ideas, his technique was not a direct application of psychoanalysis to the group, but a form of therapy, in the group, and by the group, including its conductor [21, 22, 23].

This Foulkesian conception is similar to what has been called second-order cybernetics, in which the observer is part of what is observed or treated [30].

In this way, Foulkesian group-analysis gradually became an idiosyncratic therapeutic philosophy. In this philosophy, patients are conceived as possessors, not only of problems, but also of sufficient internal resources to help each other and, ultimately, become a group of co-therapists [31].

It is true that Foulkesian theory has often been criticised as vague or imprecise, even within group analysis itself. However, this vagueness or imprecision has been perceived by others as one of its strengths and a valuable element, since it avoids dogmatism and adapts relatively flexibly to the needs of the patient.

Over time, group analysis has become a solid theoretical and clinical discipline, particularly with regard to the study of interpersonal, intragroup, and intergroup relationships and their therapeutic potential (in small, medium and large groups), as well as to the promotion of healthier communities [5].

In recent decades, group analysis has extended its approach to the study of social thought, power dynamics and political tensions [32], as well as the so-called collective or social unconscious [33].

4. Bowlby’s conception of group attachment

John Bowlby (1907–1990) was born in London only 6 years after the death of Queen Victoria. He was brought up in an upper-middle-class family where Victorian tradition was the norm. He could not establish secure attachment relationships with his parents, who left his care to a nursemaid with whom he developed an intimate attachment. However, he lost her before the age of four—a departure that he considered almost as tragic as the loss of a mother [12].

Bowlby was only seven when the First World War erupted. His father was immediately sent off to the Front. During the course of the war, Bowlby and his brother Tony were dispatched to boarding school because of the danger of air raids on London or, at least, that was what they were told. As an adult, he reflected that it was just an excuse, as part of a traditional step in the time-honoured barbarism required to produce English gentlemen [34].

Sometime later, Bowlby indicated that he had been sufficiently hurt but not sufficiently damaged, as a result of his childhood experiences. Although he never criticised his parents, his views on the attachment needs of young children could be seen as an indictment of the type of upbringing to which he had been subjected and of the culture that had fostered it [30].

In 1946, the very same year Wilfred Bion had set up the Tavistock Clinic’s group therapy programme, and in competition with Donald Winnicott, John Bowly (who had trained as a child and adolescent psychiatrist and as a psychoanalyst) was appointed as Chair of the Children and Parents Department at the Clinic.

In the early days, Bowlby was significantly influenced by Bion, but he developed his own way of applying group methods therapeutically. In fact, he laid the foundations of therapeutic group work with families, by seeing all members of the family together. And he described his work in a ground-breaking paper, The study and reduction of group tensions in the family [35], the first European publication in the field of family therapy.

In addition, Bowlby established a weekly therapy group for mothers and their babies or young children, which he called the Well-Baby Clinic. He put aside one afternoon, every week, for this group therapy project and conducted it during the course of three decades.

Not unexpectedly, group membership changed when some mothers improved and were replaced by others. He succeeded in creating a therapeutic group dynamic and culture. And he gave priority to:

… trying to help the less experienced learn from those who knew more. ([36], p. 29)

However, Bowlby [3, 37, 38, 39, 40, 41] became so involved in his research into the nature of the child’s tie to his mother and, subsequently, into the evolutionary roots and functions of human attachment throughout the life cycle, that he did not provide a detailed account of his group-therapy clinical findings, nor did he link these to his attachment theory.

At one point, he confessed that he left to others the task of integrating group therapy and attachment-based thinking [5].

Another major contribution of John Bowlby was the creation of the first research unit at the Tavistock Clinic. He promoted an aspiration that a research component should be built in to all current and future therapeutic work. That was with the aim of refining knowledge and feeding the conceptual refinement back into the subsequent clinical activities of the institution: no research without therapy and no therapy without research [11].

According to Bowlby [3, 41], attachment (like food and sexuality) is a fundamental and integral part of our existence and survival, all the way from the cradle to the grave. The strength of the instinctual component of attachment gradually allows for the establishment of meaningful, intimate and enduring interpersonal and group attachment relationships.

John Bowlby was no doubt a group person who conceived the human mind as a social phenomenon. Whilst he originally investigated the nature of the child’s attachment to the mother within the family environment [37, 38, 39], the compass of his work included other manifestations of interpersonal attachment and of group attachment through other developmental stages in the life cycle:

During adolescence and adult life, a measure of attachment behaviour is commonly directed not only towards persons outside the family but also towards groups and institutions other than the family. A school or college, a work group, a religious group or a political group can come to constitute for many people a subordinate attachment figure, and, for some people, a primary attachment figure. In such cases, it seems probable, the development of attachment to a group is mediated, at least initially, by attachment to a person holding a prominent position within that group. ([3], p. 207)

Inevitably, humans are born into a group. From birth onward, infants start to internalise group experiences, either directly or through their interactions with their attachment figures, who have mental representations of their own previous group experiences. In our evolution as a species, the group became an adaptive social organisation in the service of survival. The group is a humanising environment par excellence, and can also be a therapeutic and attachment space [42].

Undeniably, attachment theory is firmly grounded on Darwin’s theory of evolution. Primarily, attachment serves survival (both physical and emotional) and gradually becomes the basis for healthy psychosocial development throughout the life cycle. Attachment is both an in-built force for human connectedness and a significant relationship that makes life more meaningful:

Intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he is an infant or a toddler or a schoolchild but throughout his adolescence and his years of maturity as well, and on into old age. From these intimate attachments a person draws his strength and enjoyment of life and, through what he contributes, he gives strength and enjoyment to others. ([41], p. 442)

5. Discussion

We have suggested elsewhere [5] that Bion’s traumatic experiences during the two world wars and his difficult interpersonal and group attachment history contributed to his conception of the individual as a group animal who is at war with his groupishness—an assumption which he did not revise and which, in many ways, became deified and dogmatised.

Foulkes also had to endure trauma, but he was able to establish more secure interpersonal and group attachments. His group-analytic mentality, the matrix, is not at war with the individual. According to him, the broad range of negative and positive responses generated in a well-functioning group enhances, both, the person’s individuality and groupality.

This group matrix, with its emphasis on a deepening of group members’ capacity for personal insight and mutual understanding through their own contributions, as well as those of the conductor, adds a more democratic therapeutic dimension or group culture that is lacking in the defensive group mentality that Bion [25] had originally conceptualised.

In terms of attachment theory, the therapeutic group matrix (including members and the therapist or conductor) has been described as constituting a secure base or, at least, a secure-enough base [5, 12, 43, 44, 45, 46].

In its purest form, Bion’s technique provokes a significant amount of frustration; it may lead to disappointment, even hostility. However, this is not necessarily a bad thing; after all, learning to tolerate frustration without resorting to destructive anger and aggression is an important developmental task.

Having said that, too much frustration and disappointment can generate unbearable levels of anxiety and dysfunctional, even aggressive, group mentalities—particularly in the more vulnerable patients.

Foulkes gathered that, as well as repressed hostility, patients bring a feel for group connections, collaboration and meaningful and intimate social relatedness. These elements combined can contribute to the formation and development of group attachment, as conceptualised by Bowlby [3].

Group members present themselves with many different symptoms and problems, but also carry with them a wealth of experience and a capacity for supporting one another, as well as other strengths that can be used therapeutically in the group situation.

In the Bionian model, the analyst is paradoxically the sole (leaderless) group leader, and becomes the only source of higher-level functioning, interpretation and knowledge. In the Foulkesian model, the conductor is not the sole group leader, but takes the lead in enabling members to eventually constitute themselves in a group of co-therapists [31].

A group-analytic conductor is meant to foster not so much frustration, but tolerance and appreciation of individual differences—a real challenge in its own right. This distinct attitude is an effective way of encouraging members to participate actively in their own therapeutic process. Sometimes, but by no means always, such a conductor allows the group to cast him or her in the role of leader.

As the group matures through reliance on its own strength, the conductor or therapist’s role evolves from being a leader of the group to becoming a leader in the group: the authority of the conductor is integrated into the authority of the group [5].

Group Analysis is not psychoanalysis of the group as if it were a quasi-individual [17, 18, 25] or individual analysis in the group [47], but therapy of the group, by itself, including its members and the conductor [23].

Bion and Foulkes were on common ground in their recognition of an unconscious mind, with transference defence mechanisms, both in the individual and in the group. With that said, Foulkes also gave himself permission to become a member of the group and introduced a new frame of reference, in which the transference develops in a different way due to its multi-personal distribution [28].

Some group analysts have attempted to integrate both approaches [2, 5, 20, 28, 48, 49]. But these attempts at working towards a rapprochement of the Tavistock and group-analytic models have been an exception to the norm. The reality is that neither Bion nor Foulkes (or their followers) appeared to significantly influence each other, although they both approached group therapy from the perspective of the group as-a-whole.

Certainly, there has been more emphasis on the differences between the two theories and subsequent clinical modalities. By the time Foulkes came to group psychotherapy, he was an experienced psychoanalyst and saw the group as a set of individuals whose interactions and communication became his focus. In contrast to that, when Bion approached group therapy, his experience was in a large organisation (the British Army) and he focussed on the group as an entity in itself. Hence,

Foulkes applied individual psychology to groups; Bion applied organisational psychology to groups. ([49], p. 353)

In attachment terms, we may say that, in the traditional Tavistock model, it is more difficult for members to perceive the group as a secure base, although they are confronted more openly with group transference interpretations, particularly regarding possible manifestations of their unconscious hostility.

In contrast, in the group-analytic model, there is more room for the exploration of multiple aspects of the transference, including transferences of individual members to the therapist or conductor, as well as transferences amongst members themselves.

Optimally, the so-called group matrix can become a secure base for the patient to explore safely.

Nevertheless, it is striking that, in his many publications, Foulkes hardly referred to attachment or human development. In fact, the words development or attachment do not appear in any of the indexes of his books.

These terms are also absent in the index of The Practice of Group Analysis [50]. This book, with contributions from early generations of group analysts, is still largely considered a blueprint of group-analytic psychotherapy.

Consequently, in the thinking, training and practice of group analysts, past and present, there has been a concerning absence of attachment-based thinking, with only a few exceptions [5, 12, 30, 43, 44, 51, 52, 53, 54].

Fortunately, in the last two decades, other clinicians and researches have contributed to the study of attachment into the field of group psychotherapy, particularly in North America and in Europe.

In this sense, we would like to direct the reader towards the work of McCluskey [55, 56], Flores [57], Markin and Marmarosh [58], Page [59], Marmarosh et al. [60], Marmarosh and Tasca [61], Marmarosh [45, 62, 63], Tasca [64], Wajda and Makara-Studzińska [65, 66], Tasca and Maxwell [46].

We may say that, in different ways, these authors have postulated that there is a group attachment system which, based on evolution, predisposes humans to seek security and form bonds with social groups, in addition to the dyadic or interpersonal attachment system. Although these two attachment systems (dyadic and group) are different, in many ways they overlap, have important similarities, and influence and complement each other [5].

Our own view is that person-to-person attachment and person-to-group attachment represent two relatively independent but interconnected domains. In order to further investigate and understand the nature of group attachment, it is essential to identify what exactly people are attached to when they interact in the group and with the group, not only with group members or leaders, but also with the group as-a-whole.

In fact, one of us had put across a tentative definition of this important concept, which tries to integrate group analysis with attachment-based thinking. Of course, this description can be revised and improved as further research moves along:

Group attachment can be conceived as a construct that brings together a complex constellation of significant attachment relationships, in the group and with the group; that is, with its members, with its leaders and with the group as-a-whole, in order to maximise survival, protection, development, creativity and full realisation of human capabilities, as a person and as a species. [67].

6. Conclusion

The group is a deeply humanising entity with healing properties, and so can be a therapeutic and attachment space. In our evolution as a species, the group became an adaptive social organisation in the service of survival—a theme that has been at the front, in the origins of group therapy.

In fact, having to fight and survive two world wars had a strong bearing in the genesis and development of the two main models of group psychotherapy in Great Britain, those of Bion and Foulkes. Despite their differences, these approaches can be integrated and complement each other.

Certainly, no individual, however isolated in time and space, should be regarded as outside a group or lacking in multiple manifestations of group lives, including group attachment, as formulated by Bowlby in 1969 and further investigated by a number of authors, particularly in North America and Europe, in recent decades.

Group attachment is highly relevant to group psychotherapy; studying its nature and therapeutic implications should be an integral part of the training of psychotherapists and other mental health professionals across the board, especially those working with groups.

In an appropriate group climate, patients can perceive their therapy group as an attachment figure.