Illing, Hans A.

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Journal of Criminal Law and CriminologyVolume 44 | Issue 6 Article 51954The Visitor and His Role of Transference in GroupTherapyHans A. IllingFollow this and additional works at: https://scholarlycommons.law.northwestern.edu/jclcPart of the Criminal Law Commons, Criminology Commons, and the Criminology and CriminalJustice CommonsThis Article is brought to you for free and open access by Northwestern University School of Law Scholarly Commons. It has been accepted forinclusion in Journal of Criminal Law and Criminology by an authorized editor of Northwestern University School of Law Scholarly Commons.Recommended CitationHans A. Illing, The Visitor and His Role of Transference in Group Therapy, 44 J. Crim. L. Criminology & Police Sci. 753 (1953-1954)THE "VISITOR" AND HIS ROLE OF TRANSFERENCEIN GROUP THERAPYHans A. IllingThe author is Chief of Social Service and Group Psychotherapist in Mount SinaiHospital and Clinic, Los Angeles, California. He is author of contributions to theInternational Journal of Group Psychotherapy, the Journal of Child Psychiatry andother professional periodicals. Dr. Illing is soon to publish a volume entitledCurrent Trends in Group Therapy-EDToR.The majority of the patients with whom this paper deals are con-victs, serving their prison term and being simultaneously treated onTerminal Island in the harbor of Los Angeles.It was Freud who first described the processes of transferences inpyschotherapy. While the degree of transference depends on thepatient's ego strength, its importance is interlinked with the therapist.As S. R. Slavson states, "Expression of hostility toward the therapistin the transference relation is a primary requirement in psychotherapy."'This requirement includes group psychotherapy. Fenichel recognizedthe importance of this aid nearly two decades ago; he restated the im-portance of the transference reaction in groups in these words: "Theexamples of the others with whom the patient can identify himself, andthe general tendency to undo instinctual derivatives and mental differ-entiations when in a group, may help to overcome resistances."'2Until very recently, it seems, the knowledge of group sessions withmore than one therapist, and the literature were rather scarce. It seemsto this writer that the actual types of multi-therapist are three: the co-therapist, the observer, and the "visitor." Of the first two, the co-therapist appears to be the type best known. Only recently Solomon,Loeffler, and Frank described their experience in this field adequately.3The observer's role is less clearly defined. While the co-therapist has tostructure his methodology according to the group, without necessarily"diluting" the process of transference, as Slavson thinks will happen,the observer may not have any role at all other than just "observing;"otherwise, his role may hardly serve any definite purpose.For instance, the editors of Group Psychotherapy are positive thatthe observer's primary interest "in research is an outstanding require-ment. 14  Another role, that of the supervisor, was discussed in a recentpaper, which threw light on the many difficulties hindering effective1. SLAVSON, S. R., ANALYTIC GROUP PSYCHOTHERAPY: Columbia Univ. Press. (P. 21).2. FENICHEL, Orro, THE PSYCHOANALYTICAL THEORY OF NEUROSIS. W. W. Norton. P. 567.3. SOLOMON, ADRIAN, FRANK J. LOEFFLER AND GEORGE H. FRANi, An Analysis of Co-Therapist Interaction in Group Psychotherapy, INTERNAT. J. GROUP PSYCHOTHERAPY, III:171-180, 1953.4. POWDERMAKER, FLORENCE B. AND JEROME D. FRANK-GROUP PSYCHOTHERAPY. HarvardUniversity Press. Pp. 12, 13, 14.HANS A. ILLINGtransference. Thus Grotjahn tells us that the supervisor has a chanceto demonstrate to the therapist through actions his criticisms withoutthe slightest intimation of "showing the therapist up." 5 Similar prob-lems will be manifested in increased spontaneity, in a directness andfrankness of expression bordering on group associations free of anxietyand defensiveness.6All these types of observers, including students, can be considered asprofessional practitioners. For the sake of completeness, another, non-professional type should be mentioned here briefly. He functions mostlyin correctional settings, such as were mentioned by this writer pre-viously. 7  Or he is a member of ward personnel in mental hospitalsettings, well explored by Klemes.8How about the role of the "visitor?" He resembles that of the manwho came to dinner-uninvited. He may or may not be a psychother-apist. If he is, his role will have to be structured precisely; it will bethat of a silent outsider. As already stated, little is known about the"visitor," and Ruesch and Bateson offer little in this direction. 9This writer had the experience of being the "visitor" with severalgroups a few times. The little known agency, the Medical Facility, adivision of the California State Department of Correction, has beenbut a few years in existence and is located on Terminal Island, in theharbor of the City of Los Angeles. Of its 1,200 inmates, approxi-mately 120 are patients afflicted with tuberculosis at all stages, in addi-tion to their emotional problems. The remainder are classified as"psychopaths," and include psychotics. The majority of these patientsare convicts, serving their prison term and being simultaneously treatedon Terminal Island, since this is the only such facility in the state. Anumber of the tubercular patients are not offenders under the PenalCode, but were convicted as being "recalcitrant" against the laws pro-tecting the citizens from contagious diseases.The group psychotherapy program at the Medical Facility, then,was initiated in September, 1950. At that time two groups were formed,each consisting of forty to fifty patients. The patients were chosenfrom among the younger men and the sex offenders because greater5. GROTJAHN, MARTIN, Special Problems in the Supervision of Group Psychotherapy,GROUP PSYCHOTHERAPY, J. SOCIOPSYCHOPATHOLOGY AND SOCIATRY, 111:308-315, 1951.6. GROTJAHN, MARTIN, Experience qvith Group Psychotherapy as a Method of Treatmentfor Veterans. AMERICAN J. PSYCHIATRY, 103:637, 1947.7. ILLING, HANS A., The Prisoner in his Group, INTERNATIONAL J. GROUP PSYCHOTHERAPY,1:274, 1951.8. KLEMES, MARVIN A., The Therapeutic Effect of Group Morale on a Psychiatric Hos-pital Ward, BULL. MENNINGER CLINIC, 15:58, 1951.9. RUESCH, J. AND G. BATESON, Structure and Process in Social Relations, PSYCHIATRY,12:105-124, 1949.[VOL. 44GROUP THERAPYemphasis was to be placed on their treatment. Later, as additions tothe staff were made, more meetings were added.At present ninety-six group psychotherapy sessions are held weekly,a program perhaps unique in this country. All but five of the prsentgroups are small consisting of from five to twelve patients apiece. Thelarger ones vary in size from thirty to forty patients. Differentpatients are assigned to each of these and attend one group session aweek regularly. Some patients have requested permission to attendmore than one session a week so as to avail themselves of asmuch treatment as possible while confined in the Facility. Besidesthe consulting Psychiatrist and two Staff Psychiatrists, there areone Senior Physician, two Senior Clinical Psychologists, and twoSenior Sociologists participating actively in the group psychotherapyprogram. Of the approximately 1,200 patients, about 850 are able toparticipate in group sessions. Some of the psychotic and tubercularpatients are not suited to this form of therapy; some of the regularward patients do not care to participate but resist psychotherapy.According to Showstack, "the method used in group psychotherapy isanalytical, based upon the existence of unconscious emotional circuitspresent in the patient's mind of which he is totally unaware, but whichled to abnormal behavior. By raising these circuits to the surface ofconsciousness so that they are observed by the individual in whom theyoccur, and by members of the groups, the patient gradually becomesaware of the immature, even infantile, emotional circuits of his un-conscious mind. Thus, the patient, as well as the others, can viewthese abnormal residuals that reside within him and which lead to hiscriminal behavior, with an adult mind. Gradually the elimination ofthose harmful eifiotional states changes the patient's total existence fromone of fear, hate, and lack of identification with authority, to happi-ness, love, and return to faith in the authority of God and the laws ofthe land."' 0TRANSFERENCE TOWARD THE THERAPISTFor development of transference toward people it has been shownthat "attention to meaningful details, such as seating arrangement,is important.":" In both groups, the sessions started with a bustlingof the chairs, some group members indicating their unwillingnessto be patients by seating themselves as far in the background as10. SHOWSTACK, NATHANIEL, Group Psychotherapy at the California Medical Facility, Re-port to the California State Dept. of Correction, May 29, 1952. (mimeographed)11. GROTJAHN, MARTIN, Problems of Countertransference in Group Psychotherapy,INTERNATIONAL J. GROUP PSYCHOTHERAPY, III: 407-416, 1953.1954]HANS .4. ILLINGpossible. At each of the two sessions the goal of the therapy seemedto be to secure emotional participation. The members conversed moreor less freely with each other and with the therapist, but all their talk-ing *ras obviously on a conscious plane; equally obviously, a quicktransference was established, consciously, with the therapist. Thegroups, however, in their inability to "challenge the therapist, ' 12 didnot fulfill the pattern of procedure laid down by Grotjahn.' 3 Theirinability to utilize insights constructively and to interpret whateverfeelings were caused was evident all the time. The visitor had to assumethat the patients' ego strength was not being hid under a bushel, but thatit was weak and whatever was exposed all too loudly and proudly wasfor purposes of demonstration rather than therapy.While the institution housed offenders of all types, it appears that aproportionately high percentage of them were classified as sexual psycho-paths. In fact, the majority of the members in each group had beenconvicted on a sex offense, usually rape, but also in two instances of en-gaging in sex perversion with small children. Since both groups con-tained a majority of sex offenders, a discussion of sex and the offenders'sexual misdeeds seemed a natural topic. The content of both sessions,therefore, was alike, but everything else, i.e., transference toward thetherapist, methodology and conceptualization of the subject, was di-vergent.In Group A, one member talked continuously, with the other mem-bers chiming in now and then. From his revelations of his many rapesand the "technique" of his rape, the writer was reminded by him ofthe fetishist as described by Stekel: "The fetish lover is a Don Juantype or has, at least, secret appetites of this kind. But they are at warwith his inner morality. Instead of collecting women, however, he col-lects fetishes."' 4 He dwelt upon his early childhood, his sexual manipu-lations and how he came to the conclusion that his subsequent "career"of crime was the only way to go on. While the members of the groupseemed to agree that crime paid "up to a point," they admired, or dis-agreed with, the man's insight that his trail of crime was due to his earlychildhood. It seemed to the visitor then that some of the unconsciousmotives, outwardly those of resistance to therapy, came to the surfacefor an all too brief moment.12. GOLDFARB, WALTER; PAUL PARK, Dynamic Role of Group Therapy in the total Treat-ment Program of Psychotic Patients, AMERICAN J. PSYCHOTHERAPY, V:518, 1951.13. GROTJAHN, MARTIN, The Process of Maturation in Group Therapy and in the GroupTherapist, PSYCHIATRY, 13:63, 1950.14. STEKEL, WILHELM, Sexual dberrations. The Phenomena of Fetishism in Relationto Sex. New York: Livenight, 1932 and 1950, p. 21.[Vol. 44GROUP THER4PYThe member in Group B who did all the talking was also a sexoffender convicted of rape. But his memories did not go back to hischildhood. This member dwelt on the present, and very much so. Mostof his analysis centered around dreams. The patient always giggledwhen he started the narrative of a dream, saying that he did not re-member which shape, human or animal, he represented, similar to thatChinese poet as quoted from Fromm: "I dreamt last night that I was abutterfly and now I don't know whether I am a man who dreamt hewas a butterfly or perhaps a butterfly who dreams now that he is aman.' 5 He was forever wishing to sleep and looked forward to hisdreams in order to have the gratification of wish-fulfillment. Throughhis dreams this member revealed some of his unconscious motives tothe groups in the way as Freud had summed it up with, "Every suc-cessful dream is a fulfillment of the patient's wish.'6In both groups the transference toward the therapist seemed to bewell established for many sessions. How did this transference phenom-enon change and, if so, in which way when the visitor entered thescene?TRANSFERENCE TOWARD THE VISITORIn Group A, the visitor was introduced to the group at once by thetherapist and remained mute, tacit, and unnoticed for the rest of thesession. In Group B, the therapist absentmindedly omitted the intro-duction and the group loudly demanded to know who the visitor was.Immediately after the therapist's introduction of the visitor to GroupA, one member seized the conversation and managed to remain thecenter of "attraction" for the rest of the session. While the visitorapparently was forgotten, the former sensed some "atmospheric" cur-rent between the group and him. When the patient continued to unloadhis childhood experiences, stressing his Don-Juan nature with self-conscious vanity, the group seemed to look to the visitor rather than tothe therapist for approval. According to the therapist, this patientused the same technique of verbal exhibitionism anytime a visitor waspresent!In Group B, the members had taken a keener interest in the visitorthan those of Group A. Yet, when the principal protagonist spoke ofhis many dreams, the members seemed to have forgotten the visitorentirely. At no time did the visitor have the impression that any trans-ference of the group toward him was effected.15. FROMM, ERICH, THE FORGOTTEN LANGUAGE, New York, Rinehart, 1951, p. 5.16. FREUD, SIGMUND, THE INTERPRETATION OF DREAMS, New York: Carton House, 1931,p. 134.1954]HANS 4. ILLINGINTERPRETATION OF THE VISITORThe therapist of Group B interpreted freely, as he seemed to haveless experience. On the other hand, he used interpretation appropriately,because the patient's "expressions of specific emotional trends (were)sufficiently solidified."'17 This theory seems to correspond with that ofSchilder, who maintains that a body of knowledge has in itself a moralpoint of view and practically forces definite action by the therapist. 18The visitor was also prone to side with Slavson that the group leader'ssuccess depends on "solidity as well as flexibility of its own personalityintegration, suitability of temperament, capacity of understanding others,emphatic index, knowledge of the complexities of behavior and his train-ing and experience in the specialty."19The visitor also seemed to note that, in view of the protagonists' seiz-ing the conversation for the duration of the sessions, the therapists weredistracted from the group in toto and concentrated on one patient only.This experience coincided with the conclusions of Gorlow, Hoch, andTelschow who found that "group leaders consistently interact more fre-quently with the more active group members.20 Both therapists seemedto be unaware of it, when the visitor called the "one-sided" interactionwith one patient to their attention, but claimed that "at least one mem-ber" seemed to have benefited by "opening up."CONCLUSIONSThe above-described experiment will be continued. As already stated,much of this writer's comments are based on impressions rather thanscientifically based facts. While the role of a visitor appears to bedistinctly different from that of a co-therapist or an observer, thiswriter wished to point out some of the generic elements in transferencecommon to most, if not all, situations.It seems significant to this writer that the "permissive atmosphere"without which effective psychotherapy is not feasible can be possible andrealistic in a correctional setting, such as the one described at theMedical Facility on Terminal Island.17. ACKERMAN, NATHAN M., Some Theoretical A4spects of Group Psychotherapy, in J. L.MORENO (Ed.), GROUP PSYCHOTHERAPY: A SYMPOSIUM, New York: Beacon House, 1945.18. SCHILDER, PAUL, Results and Problems of Group Psychotherapy in Severe Neuroses,MENTAL HYGIENE, 23:87-99, 1939.19. SLAVSON, S. H., THE PRACTICE OF GROUP THERAPY, New York: International Univer-sities Press, 1947.20. GORLOW, LEON; ERASMUS L. HOCH; and EARL F. TELSCHOW, THE NATURE OF NON-DIRECTIVE GROUP PSYCHOTHERAPY, New York; Teachers College, Columbia University, 1952,p. 108.[Vol. 44

The Visitor and His Role of Transference in Group Therapy

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The Visitor and His Role of Transference in Group Therapy

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