ABSTRACT
Most of the techniques which I have outlined in this book have been based on the assumption that their effects could best be achieved in confidential, tête-à-tête conversations between patient and therapist. This assumption arose naturally from Freud’s original theory that the therapeutic process worked in a cathartic way, and that the patient grew better through purging herself of secret thoughts and memories. If this were so, it seemed to follow that she would unburden herself more readily and thoroughly if she were talking in complete confidence and privacy to one person. Although the inadequacies of the cathartic theory were fairly soon recognized by psychoanalysts, including Freud himself, 1 several assumptions based on it have survived, and this is one of them. The typical psychotherapeutic interview is still carried on in complete privacy. Since even the treatment of the mildest disorders by the most superficial psychotherapeutic technique requires numerous and frequent interviews, each between half an hour and an hour in length, the result is that very few patients can be treated at any one time by a single psychotherapist. Twelve sessions a day on five and a half days a week are the practical limit for any normal psychotherapist, and even this places quite a strain on him. If he sees the average patient three times a week this will allow him to have not more than twenty-two under treatment at any one time. This doctor-patient ratio of 1 : 22 is very much lower than in any other field of medicine, and is of course the reason why psychotherapeutic treatment is so expensive. As a result, institutions which have to cope with large quantities of neurotic or psychotic patients—such as State or Military hospitals—are taking an increasing interest in the possibility of treating more than one patient in the same psychotherapeutic interview; that is, in group psychotherapy. This interest is not confined to one particular school; group psychotherapy is practised by therapists from almost all the sects which we have been considering, and as we shall see its effects are interpreted by each in the light of their own theories. 1
