The Management of Anxiety in Group Psychoanalysis

The inter-reactions and the inter-relationships in group therapy serve the very valuable function of stirring up feelings, attitudes, and conflicts that have been thoroughly and carefully repressed. In individual analysis the amount of anxiety generated in the analytic process is determined by the patient's productions and the analyst's contributions. The patient appears to have a built-in self-regulating mechanism that does not permit, in the usual way, the formation of excessive amounts of anxiety. The experienced analyst does not make interpretations that will throw the patient into panic. However, in group analysis these controls do not cover the situation, and another patient's associations or ill-conceived interpretations may trigger large amounts of anxiety. In individual analysis, when a patient approaches an anxiety laden area too rapidly, or sometimes when he approaches it at all, a refractory period ensues, during which the patient may run through the gamut of conflict-avoiding devices, from assaulting the analytic process and/or the analyst to forgetting. In many such instances I get the impression of the patient cautiously circling and recircling the area, moving into it and bolting out again, as if he had stepped on a tack with his bare foot. There is no need to go into the controls and desires for avoiding anxiety in individual analysis; that is a different topic. In group analysis the different situation and exigencies create a different problem and the individual reacts in special ways to meet it.

A group patient has told me that following a group session she felt so worked up that she could not fall asleep for hours after she went to bed. Another patient said that she had to drop out of the group because she would get dizzy after just a few minutes. Her head would whirl and then she could not hear what was said or pay attention. She would sometimes feel nauseous. The line-up for the bathroom after the session and the adjournment of the meeting to a