The process approach - a historical and personal review

The process approach is a name given to therapeutic work that is done with attention to the way in which centralities in a person's life are expressed in his "here and now". The concept of 'processes' indicates that we are looking not only at 'content' - what the person tells, but also at the way in which he tells the things and the dynamics he motivates. In fact, this is an approach that preceded the intersubjective approach and that relies on thinkers from the field of group therapy. This approach, in the spirit of Sigmund Fox's concept, also assumes as a basic premise the uniqueness of each situation, and the importance of the original language that emerges in the treatment room.

The origins of the process approach

The psychoanalytic axis ~ the group axis ~ the axis of family and couple therapy ~ individual therapy and my belief

The psychoanalytic axis

On the surface, every therapeutic approach deals with the question: how does the person undergo change? But in a deeper way, every therapeutic approach also deals indirectly with the question "what is man"?

Freud, for example, the "father" of modern psychology and psychiatry, perceived man as a living dynamic between internal forces: the subconscious and the unconscious, the id, the ego and the superego. Therefore, in order to treat a person, according to Freud, it was first and foremost necessary to treat the dynamics between his inner forces. Freud proposed therapy that is essentially 'intrapersonal'. The emphasis of the 'intrapersonal' treatment is to pay attention to the healing of the person's inner world as a key to improving his relationship with the environment. This emphasis is also shared with 'intrapersonal' concepts from non-psychoanalytic schools of psychology, such as CBT

Later thinkers than Freud, began to see the person not only as a living dynamic of internal forces, but as significantly affected and inseparable from his relationships. Melanie Klein, for example, places significant emphasis on the way we internalize other people in our lives into our psyche as a basis for health or mental illness (she also relied to a certain extent on Freud and his essay 'Grief and Melancholia'). Other thinkers from the field of psychoanalysis, such as Renee Spitz, Donald Winnicket, John Bowlby and Mary Ainsworth, also began to emphasize the sometimes deterministic influence of our early relationships on our self - and especially of our main caregiver figures - mother and father.

The conceptualization of the importance of the interpersonal field in psychoanalysis was also made by a psychiatrist named Harry Stack Sullivan. Sullivan treated a person's personality as something that is not found within him, but as something that is revealed in interpersonal relationships. In this sense, Sullivan was very reminiscent of the concept of Martin Mordechai Buber who wrote the book 'I and you'. Sullivan began to investigate with his patients what was actually happening in their actual relationships - an investigation that was just as important to him as what was happening in their inner world. Sullivan's students, among them John Haley, were naturally the first to develop the field of family therapy (systemic therapy) together with Gregory Bateson - therapy that emphasizes the healing of family dynamics as a path to individual healing.

Beginning in the 1970s and prominently in the 1990s, certain psychoanalytic thinkers - similar to thinkers in the field of family therapy - began to give more and more emphasis and more weight to the concept that sees a person as being built out of his relationships. Heinz Kohut gave weight to this in his concept of the "other-self", and later therapists who called themselves 'intersubjective' began to give an even more groundbreaking voice to this concept. The latter, such as Thomas Ogden and Steven Mitchell, gave central emphasis to the mutual relationship that is forged in the treatment room between the therapist and the patient as a subject in itself that needs treatment no less than the problem the patient comes with. In other words: the actual dynamics between therapist and patient - and not just the consequences and countertransferences between therapist and patient, became part of the therapeutic context.

The group axis

Another axis where a leap was made from the intrapersonal field to the personal, was through the path of the development of group therapy.

The pioneers of group therapy were prominently Wilford Bowen and Sigmund Foulkes (SH Foulkes). Both were psychoanalysts and psychiatrists, who were also influenced by Gestalt psychology. Gestalt psychology was an early current of psychological thought, which treated the concept of the "whole" as a concept that should be explored as a background to isolated phenomena such as the individual. This concept formed a natural ground for the investigation of group dynamics.

As an echo of this concept, Sigmund Fox was one of the first people to do 'group psychotherapy'. His worldview tended to work with what he called "the matrix" or "the network" (Kurt Wertheimer called it: "field of forces") - environmental forces - people, objects and animals, which together with us create our individuality and which interact with us all the time. The goal of treatment, according to Fox, is for a person to learn to realize himself in a benevolent way within the network of his life.

Another significant thinker from the field of group therapy was Wilford Bowen. Bowen first came up with the idea of group screening of candidates for army officers and his experience in the field accumulated in a military hospital during World War II. Bion was a trailblazer in the sense that he treated the group as a whole, and made interventions intended for the group and not for the individual. Among his most important ideas was that of a group whose entire purpose is to explore its own tensions . In this sense, the ability to observe in a primary way processes occurring in the present without prejudices, became a milestone in his approach. His ideas, along with those of Fox, laid the foundation for process therapeutic groups and the process approach in general.

the even axis

The tension between the individual, the self, the personal, and the system, the group, or the "network" in which he is found, is strongly expressed in the concept of 'differentiation'. The first to conceptualize this term was Murray Bowen, a pioneering American psychiatrist, who argued that mental healing is possible when the individual is better able to express autonomy within the system of his family of origin, which pressures him to adapt to the family role it asks of him (you can learn more about this in my podcast with Ilan Yafarah, in chapter 30). The ability to change our level of differentiation vis-à-vis the family of origin, was for Bowen also critical for therapists. For Bowen, therapists can help patients improve their level of distinctiveness only to the extent that they themselves have personally grown in this area. Differentiated, according to Bowen, does not mean distance and detached independence - but the ability to be able to maintain my self within a close relationship. In other words - she is distinguished not against the other, but with the other.

The practice of general differentiation is significant for development, and was expanded by an American psychologist named David Snersch who worked in couple therapy. Senrash saw the distinctiveness as an ability that develops within a relationship and that has a significant evolutionary role: to allow us to have a strong, rich self, which is based on an original self and not a reflected self. This ability only develops within a meaningful relationship, which we don't want to give up, where the conflict between the need for an authentic self and belonging and connection becomes indelible and takes us to an emotional edge that requires us to want authentically, choose and grow. Central concepts of Snaresh include concepts such as: "the confrontation of the self", "the four points of balance" , and "intimacy through self-attack" (you can learn about all of these in depth in my podcast with Ilan and Hila Yafarah, chapter 54 and 55).

Unfortunately and in my experience, group therapists from different schools often do not know in depth and do not know how to work with tools of differentiation in the group and individual field. I choose to point this out because in my view, any therapeutic process that assumes a significant influence of the environment on the individual, must also give weight to the emotional work of differentiation within this relationship and the ability to develop a stable-flexible self within it, so that this work is truly integrative.

Individual treatment with a process approach and I believe in myself

The main part of my initial training (and the most significant in my growth path for me), was as a group facilitator in a process approach based on Fox and Bion's approach. However, over the years and experience it became more and more clear to me how much everything I do even in individual therapy is based to a decisive extent on the experiences, experience and insights I acquired in the process approach. I began to recognize that the process approach is no longer a "method" or a "form of treatment", but a form of observation. In my understanding, the person in the treatment room brings a unique question into the room - and this question becomes something that speaks to both of us, through what arises between us in the present - and that we are both responsible for giving it a reference by being fully present and confronting its effect on us. In this way, the therapeutic act becomes very, very mutual, requiring the full presence of both of us and also a confrontation with the parts of us that are not present in the present moment. In this sense, the individual treatment invites engagement both with "there and then" (the content that the patient brings from what is happening outside the room), and with the "here and now" that is happening.

Naturally, I began to feel a deep identification with therapists from the intersubjective stream, who reached similar conclusions from their psychoanalytic axis. However, I see my work as a natural extension of the world of group therapy. My deep journey in the process approach is for me a natural basis for understanding the connection between what happens in the individual treatment room and what happens in the "big group" - facing the world, and in intimate and professional relationships. The relationship between them is what interests me and what I choose to explore in diverse therapeutic ways.