- Email: [email protected]
GROUP-ANALYTIC PSYCHOTHERAPY
220 MECHANICAL RESPIRATION read with great interest Dr. Ritchie Russell’s SIR,—I letter of July 23. I shall certainly get the publication he mentions to see whether the Americans are able to do more than we are. I mentioned the Oxford inhaler because many small hospitals might have an inhaler in the anæsthetic department and could therefore start treatment with it immediately. The inflator is better if it is available. The McKesson resuscitator is timed with the respiratory rate which suits the patient, but we find most patients need practice in its use ; once they have learnt to use it it is very satisfactory and its administration needs less
manually worked apparatus ; it is also of nursing time. The illustration of the Stille respirator in my article shows the advantages-namely, the limbs are free for physiotherapy, if tracheotomy is necessary it can be done since there is no collar, and catheterisation is an easy matter. The chief disadvantage is that the machine is not fitted for all sizes of patient, and therefore I suggested that a greater range of shields should be obtainable. I agree with Dr. Ritchie Russell that bulbar cases should not be treated in a respirator, but if respiratory failure supervenes the only treatment is postural drainage, mechanical respiration, suction of mucus, and perhaps in some cases tracheotomy in addition. Western Hospital, URSULA BLACKWELL. skill than a
great
a
saver
London, S.W.6.
GROUP-ANALYTIC PSYCHOTHERAPY
patients from the group." I think you fail to distinguish between the group-analytic situation proper, and episodes described in my book to illustrate group dynamics, which took place in a totally different context. This may be my fault for not having stressed the difference sufficiently. Finally, as to " casualties "-by which is meant patients who stay away after one or two sessions. Such patients are not particularly common in my experience; but I cannot say in the absence of figures whether they difficult
are
more
group
,
"
both here and in the U.S.A., refer to their forms of group treatment as " group analysis" or "analytic group therapy " and the like, under which labels they practise a number of widely different techniques, differing not only from my own but also from each other. There are also a great variety of group treatments going on which may be called supportive, but neither the one nor the other of these types of approach has had much influence on my own, either historically or factually, so far. In the second place you fall into the same error as most people, who think, when they hear of group analysis, that they must be dealing with a direct application of psycho-analysis. In my book I make a point of showing that this concept is wrong. It is as desirable for psycho-analysis as for group analysis that this mistake should be avoided. Thirdly, I agree with you that the group situation exerts a strong supportive influence; so also, in my opinion, does the conductor, whether he knows or wants it or not, in his capacity as an archaic leader (father) figure. Any form of group treatment is bound to mobilise these forces in one way or another, whether blindly or deliberately. In group analysis these supportive energies are used principally to sustain the group in the analytic process, and not for their more immediate therapeutic effect, great as this is. Direct supportive remarks and actions play no significant part in my approach ; and guidance, admonishment, reassurance, &c., with which you credit me, are not in my repertoire -not to speak of " punishing " actions or " removing
less
common
with
me
than with other
Moreover, they do not leave "ill
of reassurance." On the contrary, their number could easily be reduced if more influence were exerted to induce them to carry on. The point I wanted (but apparently have failed) to make is that this self-selecting process, just because it is allowed to take effect, is a good example of the diagnostic value of the group situation, and its economy. In cases of this kind, the economy is genuine because the consequences are wholly favourable-to both the group and the particular patient (the " casualty ")-provided the situation is correctly handled and followed through by the therapist. I gave some illustrative examples in the book. The patient who is thus excluded by the group, or takes himself off, belongs usually to one of three categories : either he is not amenable to successful psychotherapy at the time; or he needs special individual attention or he can (at least ideally) be absorbed into another group where he miarht well thrive. S. H. FOULKES. London, W.I.
spite
SIR,—May I take up some of the points raised in your review of my book Introduction to Group-Analytic Psychotherapy (June 18) First, my approach is not " a mixture of psychoanalytic and ’supportive ’ measures." It is a consistent development of a method and an integrated body of concepts ; and this book is an attempt to give’an introductory account of these, since they were first put into operation ten years ago. This method of group psychotherapy represents a principle of orientation which I have designated " group analysis " or group-analytic." I am aware that more recently a number of group therapists,
or
therapists.
THE PLACENTAL BARRIER
SiR,,-The following results appear to be of some interest in relation to the passage of hormones across the
placenta. A patient near term was found on vaginal biopsy to have chorionepithelioma. The Aschheim-Zondek test was done in dilutions of 1/10, 1/100, and 1/1000, using2 ml. for each The 1/1000 gave a weak positive reaction, the others mouse. strongly positive reactions. Delivery was by section, and the first sample of the baby’s urine, passed within 48 hours of birth, was examined ; undiluted, it gave a negative AschheimZondek test. Three months later the test was again negative. The diagnosis in the case of the mother was confirmed post mortem.
In view of the great quantity of hormone in the maternal circulation, these findings appear to show that the chorionic gonadotropin does not pass the placenta. Bernhard Baron Memorial Research Laboratories, Queen Charlotte’s
Maternity Hospital,
London.
R.
M.
JOHN
CALMAN
MURRAY.
GRADING
of the discrepancies in the grading of consultants are attributable to the lack of criteria. The St. Helier Group Medical Advisory Committee believe that to be graded as a consultant a specialist should (1) have held an appropriate higher qualification for five or more years, (2) have had training and experience m his specialty, (3) be capable of practising his specialty without supervision, (4) have held a hospital staff appointment prior to July 5, 1948, and (5) be recognised by his colleagues, in his district, as a specialist. In considering the senior medical staff of our hospitals the committee find that they are divisible into three main groups :
SIR,—Many
.
1.—Those who are entirely engaged in specialist practice, hold an appropriate higher qualification, and have a hospital appointment as a specialist, should without question be recognised automatically as of consultant status. 2.-Those not entirely engaged in specialist practice but holding an appropriate higher qualification and a specialist hospital appointment and recognised by their colleagues in the district as specialists, should also have consultant status.
manually worked apparatus ; it is also of nursing time. The illustration of the Stille respirator in my article shows the advantages-namely, the limbs are free for physiotherapy, if tracheotomy is necessary it can be done since there is no collar, and catheterisation is an easy matter. The chief disadvantage is that the machine is not fitted for all sizes of patient, and therefore I suggested that a greater range of shields should be obtainable. I agree with Dr. Ritchie Russell that bulbar cases should not be treated in a respirator, but if respiratory failure supervenes the only treatment is postural drainage, mechanical respiration, suction of mucus, and perhaps in some cases tracheotomy in addition. Western Hospital, URSULA BLACKWELL. skill than a
great
a
saver
London, S.W.6.
GROUP-ANALYTIC PSYCHOTHERAPY
patients from the group." I think you fail to distinguish between the group-analytic situation proper, and episodes described in my book to illustrate group dynamics, which took place in a totally different context. This may be my fault for not having stressed the difference sufficiently. Finally, as to " casualties "-by which is meant patients who stay away after one or two sessions. Such patients are not particularly common in my experience; but I cannot say in the absence of figures whether they difficult
are
more
group
,
"
both here and in the U.S.A., refer to their forms of group treatment as " group analysis" or "analytic group therapy " and the like, under which labels they practise a number of widely different techniques, differing not only from my own but also from each other. There are also a great variety of group treatments going on which may be called supportive, but neither the one nor the other of these types of approach has had much influence on my own, either historically or factually, so far. In the second place you fall into the same error as most people, who think, when they hear of group analysis, that they must be dealing with a direct application of psycho-analysis. In my book I make a point of showing that this concept is wrong. It is as desirable for psycho-analysis as for group analysis that this mistake should be avoided. Thirdly, I agree with you that the group situation exerts a strong supportive influence; so also, in my opinion, does the conductor, whether he knows or wants it or not, in his capacity as an archaic leader (father) figure. Any form of group treatment is bound to mobilise these forces in one way or another, whether blindly or deliberately. In group analysis these supportive energies are used principally to sustain the group in the analytic process, and not for their more immediate therapeutic effect, great as this is. Direct supportive remarks and actions play no significant part in my approach ; and guidance, admonishment, reassurance, &c., with which you credit me, are not in my repertoire -not to speak of " punishing " actions or " removing
less
common
with
me
than with other
Moreover, they do not leave "ill
of reassurance." On the contrary, their number could easily be reduced if more influence were exerted to induce them to carry on. The point I wanted (but apparently have failed) to make is that this self-selecting process, just because it is allowed to take effect, is a good example of the diagnostic value of the group situation, and its economy. In cases of this kind, the economy is genuine because the consequences are wholly favourable-to both the group and the particular patient (the " casualty ")-provided the situation is correctly handled and followed through by the therapist. I gave some illustrative examples in the book. The patient who is thus excluded by the group, or takes himself off, belongs usually to one of three categories : either he is not amenable to successful psychotherapy at the time; or he needs special individual attention or he can (at least ideally) be absorbed into another group where he miarht well thrive. S. H. FOULKES. London, W.I.
spite
SIR,—May I take up some of the points raised in your review of my book Introduction to Group-Analytic Psychotherapy (June 18) First, my approach is not " a mixture of psychoanalytic and ’supportive ’ measures." It is a consistent development of a method and an integrated body of concepts ; and this book is an attempt to give’an introductory account of these, since they were first put into operation ten years ago. This method of group psychotherapy represents a principle of orientation which I have designated " group analysis " or group-analytic." I am aware that more recently a number of group therapists,
or
therapists.
THE PLACENTAL BARRIER
SiR,,-The following results appear to be of some interest in relation to the passage of hormones across the
placenta. A patient near term was found on vaginal biopsy to have chorionepithelioma. The Aschheim-Zondek test was done in dilutions of 1/10, 1/100, and 1/1000, using2 ml. for each The 1/1000 gave a weak positive reaction, the others mouse. strongly positive reactions. Delivery was by section, and the first sample of the baby’s urine, passed within 48 hours of birth, was examined ; undiluted, it gave a negative AschheimZondek test. Three months later the test was again negative. The diagnosis in the case of the mother was confirmed post mortem.
In view of the great quantity of hormone in the maternal circulation, these findings appear to show that the chorionic gonadotropin does not pass the placenta. Bernhard Baron Memorial Research Laboratories, Queen Charlotte’s
Maternity Hospital,
London.
R.
M.
JOHN
CALMAN
MURRAY.
GRADING
of the discrepancies in the grading of consultants are attributable to the lack of criteria. The St. Helier Group Medical Advisory Committee believe that to be graded as a consultant a specialist should (1) have held an appropriate higher qualification for five or more years, (2) have had training and experience m his specialty, (3) be capable of practising his specialty without supervision, (4) have held a hospital staff appointment prior to July 5, 1948, and (5) be recognised by his colleagues, in his district, as a specialist. In considering the senior medical staff of our hospitals the committee find that they are divisible into three main groups :
SIR,—Many
.
1.—Those who are entirely engaged in specialist practice, hold an appropriate higher qualification, and have a hospital appointment as a specialist, should without question be recognised automatically as of consultant status. 2.-Those not entirely engaged in specialist practice but holding an appropriate higher qualification and a specialist hospital appointment and recognised by their colleagues in the district as specialists, should also have consultant status.