Prof. Joseph Levine

Discussion #4: REFERENCE GROUP FOCUSED TREATMENT

By Prof. Levine & Dr. Salganik

“A man is the world in its fullness" – there is nothing like this sentence to emphasize the connection between the environment in which man lives and his inner world. From the moment a person is born until his death he is subject to environmental influence. Like a sponge he absorbs some of the characteristics of the significant people in his life. Each of these characters, known as the Reference Group (RG), actually shapes us, our attitudes, our emotional world, and ultimately our behavior as well.

These groups can influence us directly, with the greater social impact if the related RG is perceived as a more significant one. It can also influence us in a more complex way that is not immediately recognizable: when important reference groups undergo an internalization process and become an integral part of a person and operate within us even when the original reference groups no longer exist. Some of these effects, without permeating the consciousness, make us a kind of a "robot" performing a scenario that is not ours, according to the "software" written by other people who have now become our inner characters and an integral part of our world.

The many conflicts that take place between these inner characters themselves and, then, between these characters and the person’s contemporary reference groups can, at worst, cause a person to go through mental crisis up to the degree of a real mental disorder.

Most mental disorders start or worsen due to the stressful situations. It turned out that a significant proportion of these situations occur in a context of the social groups to which a person belongs.

The Reference Group Focused Therapy – RGFT – ( see previous conversations) – sets as one of its important goals to bring to consciousness the impact of a social influence upon a person most of which a person is unaware of. RGFT allows a patient to better understand the psychic forces at work within him and facilitates a better adaptation to the society in which he lives. The treatment is based on a number of theories that originate in social psychology, in addition to theories of object relations, and some others which are described below.

RGFT can be applied to patients with diverse mental problems, such, for example, as Adjustment Disorder, Phobias, Obsessive-Compulsive Disorder, and others. The method is suitable for different age groups, including also the third age where the collapse of the support system i.e, reference groups, becomes a major problem.

After this general introduction we would like to say some words about what actually brought us to develop the RGFT:

First, is to mention that the development of this approach stemmed from a search for a holistic, integrative treatment method that would take into account not only the individual parameters of a patient (as is the case in individual psychotherapy), or of the parameters of a single, relevant to a patient group (as in couple, group, and family therapies), but will address the whole social matrix of the patient, including his subcultural background.

It seemed to us that social psychology with its focus on social influence offered itself as a natural starting point for the development of such an approach.

Here we give a short description, without going into too much detail, of some theories related to individual and social psychology, that were taken into account while developing the RGFT:

Reference Group Theory (Hyman)

The term "reference group" was first used by Hyman, who expanded the concept and examined some of its features in his article "The Psychology of Status" (1942). In an attempt to understand the ways in which people rated themselves in terms of their choice in a particular social setting, he first examined, through an interview, the reference groups and reference people which the subjects used, and some of the dynamics underlying such choice. He used then experimental manipulation to determine the effects of certain reference groups on a person's self-esteem.

Self-Categorization Theory (Turner)

Self-categorization theory is a theory in social psychology that describes the circumstances under which a person will perceive collections of people (including themselves) as a group, as well as the consequences of perceiving people in group terms.

Field Theory (Kurt Lewin)

Kurt Levin's field theory argues that behavior is derived from the totality of the existing forces that influence and exist in the living space of the individual or group (Lewin 1942).

Kurt Levin

Conformity Experiments (Milgram, Ash, Zimbardo)

The collective findings of Ash, Milgram, and Zimbardo's conformity trials show sensational findings – since between 61% and 66% of all participants, regardless of time or place or study methodology, were willing to exhibit some type of irrational behavior while being exposed to social influence, including even readiness to harm other people.

Behaviorism: Social Learning Theory (Bandura)

The theory of social learning, proposed by Albert Bandura, emphasizes the importance of observing, modeling, and imitating the behaviors, attitudes, and emotional responses of others. Social learning theory examines how both environmental and cognitive factors interact with each other to influence human learning and behavior.

Developmental Psychology: Attachment Theory

Attachment theory, in developmental psychology, holds, among other things, that humans are born with the need to form a close emotional bond with a caregiver and that such a bond will develop during the first six months of a child's life if the caregiver responds properly.

Alongside these, the insights derived from the following theories and approaches were also taken into account:

Gestalt Theoretical Psychotherapy (Wertheimer)

Multiple Self Theories:

Object Relations (Independent Group – Fairbairn, Guntrip)

Voice Dialogue (Hal & Sidra Stone)

Transactional Analysis (Eric Berne)

Psychosynthesis (Roberto Assagioli)

The following is a brief description of them:

Gestalt Psychology: Gestalt Theory (Wertheimer)

Gestalt theory emphasizes that the whole is more than its parts. That is, the properties of the whole cannot be deduced from the analysis of the parts only. The word Gestalt is used in modern German to describe how a certain thing was "placed" or "assembled".

Gestalt Therapy (Franz Perls)

Gestalt therapy operates out of a belief that diagnostic discoveries, insights, and therapeutic change processes are inseparable even if each of them is related to different functions and therefore to certain requirements. Effective patient support therefore requires professional and correct interactions of these discovery processes and processes of change throughout psychiatric care. Each new diagnostic discovery is inherently related to the change and may trigger a series of additional changes, which in turn may result in new diagnostic discoveries.

Multiple Self-Theories

A conception of the self as consisting of many different self-states with different emotional, perceptual and cognitive qualities. In normal development, these self-states are sufficiently compatible to allow for the existence of internal conflicts of desires and aspirations within the human psyche.

Object Relationships (- Fairbearn, Guntrip)

In psychoanalytic psychology the theory of object relations is a process of mental development in relation to others in childhood. This broad theoretical body contains theories or aspects of theories that deal with the study of the relationship between real and external people, as well as the internal images of these external figures and the relationship between them and each other. The theory claims that the baby's relationship with the mother mainly determines the formation of his personality in adult life. In particular, these theories emphasize that the need for attachment is the cornerstone of self-development or psychic organization that creates the sense of identity.

Voice Dialog (Hal and Sidra Stone)

Voice Dialogue is a psychotherapeutic approach developed in the 1970s, by a pair of American psychologists Dr. Hal Stone and Dr. Sidra Stone inspired by the school of Carl Gustav Jung and other approaches.

The approach sees the human psyche as naturally composed of many figures who can also be called 'parts', 'voices', 'sub-figures' and more. Each character has its own distinct personality that includes desires, impulses, needs, abilities, point of view and sensitivities.

According to this approach, all figures exist in all human beings, a kind of psychic DNA, but in each person and in different cultures, different figures will be expressed in different ways and intensities.

Working with people in 'Voice Dialogue' excels in a non-pathological approach to the human psyche and in the acceptance of all the characters whatever they are. The work process allows a person to get to know these characters and accept them without identifying with them, with their attitudes, or with their life experience.

Illustration as perceived by the illustrator in the "Voice Dialog"

Transaction Analysis (Eric Berne)

Transactional analysis (TA) is a psychoanalytic theory and method of treatment in which social interactions (or "transactions") are analyzed to determine the ego state of a communicator (whether he is parent-like, childish or adult-like) as a basis for understanding behavior and a method of treatment.

Eric Berne

Psychosynthesis (Roberto Asgioli)

Psychosynthesis is an approach to psychology that expands the boundaries of the field by identifying a deeper center of self-identity, as the foundation of the self. It regards each person as a unique individual in terms of purpose in life, and attaches value to the study of human potential. The approach combines spiritual development with psychological healing by exploring the learning and development of a person's life journey or his unique path to self-fulfillment.

It should also be noted that the RGFT treatment method takes into account not only the external human reference groups (in other words groups existing in reality – such as family, workplace, friends, religious group, hobby-related groups, etc.) but also the internalized groups and figures of a patient who are mostly human beings who have influenced the patient's inner world.

An interesting point is that although the internalized character or characters are usually or almost always of human origin, they do not have to be such; they can evolve from a book or a movie that left a long lasing impact upon a person, it could be even a much loved pet.

In this context of internalized non-human figures, one could perhaps mention Kafka's story "The Metamorphosis". This short story was published in Leipzig in 1915. The protagonist of the story Gregor Samsa discovers that he has become an insect with rounded armor, insect legs and a repulsive roughness.

This story has many interpretations. Could it also be interpreted in a way that suggests that a repulsive insect with all its characteristics has become a character in the inner world of Gregor?

Franz Kafka: The Metamorphosis.

Still, we would like to emphasize again that most of the inner figures originate from once really existing human beings. A human group can be internalized either with characteristics similar to a single person.

It’s important to mention that within the framework of all the internalizations, there is also internalization of the patient's subculture. Subculture is something that cannot be attributed to a particular person or group but relates to some distinctive features of a given culture: the way people greet each other, typical body language for this region of the world, the way a man is courting a woman.. We can never tell where it came from. It’s just “in the air” We can speak of a "typical Israeli", “American”, “Japanese” when we talk about some characteristics in the manner a person thinks, behaves, dresses, that are common in the relevant culture.

Finally, there is an internalization of the "Me-Self" that relates to a particular life period. There is usually not just one version of “Me-Self” within us, we may have “Me-Self” associated with our early childhood, “Me-Self” associated with our adolescence, “Me-Self” associated with our early adult life, and so on. Actually, every momentous event has a potential to produce a new “Me-Self”. It could be a school or university graduation, getting married, becoming a parent, being drafted to the army, some profoundly traumatic event, etc. It’s important to mention that the previously evolved “Me-Selves” don’t disappear, they can just become less significant.

See you in the next session,

Dr. Igor Salganik & Prof. Joseph Levine