GROUP PSYCHOTHERAPY AND GROUP WORK IN ISRAEL - 1998
Haim Weinberg
Clinical psychologist and group psychotherapist, Israel
President, Israeli Association of Group Psychotherapy
Faculty, Group Leaders' Training Program, Tel Aviv University, Israel
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This article was published simultaneously in Fehr S.S. (ed) (2000) Group Therapy in Independent Practice. Haworth Press Inc., N.Y., and in the Journal of Psychotherapy in Independent Practice. V1. pp. 43-51. 

Israelis have a reputation as being quite individualistic, but no one can compete with their social and group spirit. This quality is prominent especially in times of personal and national distress. The public’s quest for mutual help and affiliation needs are especially apparent during these stressful periods. When an Israeli is in distress, friends, neighbors, and good people will surround him to offer material or spiritual assistance. When the nation experiences difficulties, such as periods of war or waves of terror attacks, there are many spontaneous expressions of mutual help, cohesion, and getting together. There is an interesting phenomenon in Israel; group therapy blossoms after each war. People become interested in group work and more therapeutic groups become available.

Prior to 1994 there was scant attention to the group modality. Group psychotherapy has garnered greater interest and attention in the last few years following the national group therapy conference that year. The keynote speakers were Irvin Yalom, (on his first visit to Israel), and Earl Hopper. These world-renowned experts contributed to the success of this conference. The signs of group therapy’s development are numerous and are prominent in many dimensions: A growth in the number of therapists who are engaged in group-work, a rise in the number and variety of groups taking place (especially in the areas of social work), a sharp increase in the number of newly available group leaders’ training programs and in the number of students in training. Several outstanding group-psychotherapists from abroad came to Israel lately for seminars, conferences or workshops (among them Irvin Yalom, Earl Hopper, Malcolm Pines, Roy MacKenzie, Walter Stone, Morris Nitsun). On the other hand, more Israelis present papers and workshops in international conferences of group-therapy (in the last conference of the International Association of Group-Psychotherapy in London, August 98, there were 22 presentations of Israelis). The Institute of Group Analysis (IGA) from London opened a training course in group-analysis in Israel for senior therapists. The last two years, 1996-98, has seen an increase in the number of conferences and seminars in the field of group work and group therapy and a doubling of the number of members in the Israeli Association of Group Psychotherapy. A deficiency persists in the availability of Hebrew language books (either original or translated). Fluency in English allows access to the original books; others must be limited to older books and few anthologies.

Group psychotherapy in Israel is primarily influenced by the British schools of thought. American clinicians and theoreticians are less well known. The leading and most valued scholar is Wilfred Bion. The work of Foulkes is becoming increasingly respected. Beside Yalom, (following his recent visit to Israel), American clinicians and writers are unknown in Israel. In groups that are not “task focused,” the orientation is psychodynamic. On the other hand, the behavioral model influences the practical group work done by social workers in public welfare services (e.g., domestic violence, children of divorce, wives of the chronically ill.) These specific groups are generally not psychodynamic.

While group therapists in Israel maintain a high standard in their work, most group leaders are engaged in this area as secondary to their individual therapy work and do not define themselves as group psychotherapists. In Israel there is no official certification for group therapists such as the Certified Group Psychotherapist, (CGP) in America. Anyone can lead a group; certification as a psychotherapist is not mandatory. The primary therapeutic training is for individual work. Psychologists, psychiatrists, and social workers that would like to work in this area usually learn it through “on the job training” and mostly because of managers’ coercion. Those who do want to learn it in a systematic way can enroll in diploma courses that are usually associated with university social work departments. The basic requirements for acceptance are an acknowledged certification in psychotherapy and some experience in individual work. The number of applicants to these programs outnumbers the number of possible students, making this a highly selective process. Group training programs in Israel usually combine studies of one day per week for two years. However, there is no program exclusively dedicated to group-psychotherapy. If we compare the studies in these programs to the Faculty core course manual published by the AGPA (American Group Psychotherapy Association) we will find that the studies in Israel are more intensive. For example, instead of a 12 hours’ introductory course required for the CGP by AGPA, the theoretical course in the group leaders’ training programs in Israel lasts a full semester (28 hours). In addition, the students participate in a sensitivity group for one semester, take a specific course on group leader’s skills, watch a live group behind a one-way mirror, co-lead a group with a senior group-leader and are supervised for their leading

As mentioned before, every one can be a group leader in Israel, but usually group therapy is lead by psychotherapeutic experts such as psychiatrists, psychologists, social workers and expressive therapists (art, movement, music, etc.).

Although there is not yet an alphabetical index or data base of group therapists in Israel, we can get an idea about whom is doing group work in Israel by analyzing the professions’ distribution of the Israel Association of Group Psychotherapy members.

As can be seen from the table, about one third of the group psychotherapists are psychologists (almost three quarters of them are clinical psychologists), and almost 30% are social workers. Overall, a variety of experts in the therapeutic/counseling professions are doing group therapy in Israel. The number of those leading groups after graduating from training programs is increasing.

Most of the work done in Israeli groups is similar to what can be seen in any other place in the world, and the subjects dealt are universal. But, there are some unique issues that face groups in Israel. These subjects can rise in therapeutic groups, or be elaborated thoroughly in specific subject groups: conflict groups (Arab-Jews relations, left-right politics, and religious non-religious) second generation of Holocaust survivors, PTSD and reactions to wars and terrorists’ attacks. There is a lot of investment in social integration and post-traumatic issues. For example, these are some of the works presented in the Israeli group-psychotherapy conference in December 1997: 1) The division between “us” and “them” - as a universal social structure; 2) A journey of a Jewish-Arabic group - between personal and group processes, 3) Loss and bereavement in the experience of the group-therapist, 4) The open and concealed social identity (ethnic, national, gender) in the group process, 5) Groups in social-cultural conflict, 6) Parallel processes in the joint space of widows and orphans’ group, vs. the co-leaders’ unit, 7) Groups for adolescents’ parents in bereaved families, 8) A journey to the past - Holocaust child survivors deal with their memories through autobiographic writing group, 9) Couple group for second generation of Holocaust survivors, 10) Group intervention with survivors of a terror attack through CISD (critical incident stress debriefing), 11) Combined individual and group intervention with survivors of a terrorist attack.

Times of war, waves of terrorist threats and periods of military insecurity become manifest in the group; the intense atmosphere might be reflected in acted-out aggression or expressed through subjects of existential anxieties raised in the group. Sometimes the group-leader can identify parallel process between what is going on in the group and in society at large, as defense mechanisms of split and projective identification are very intensive. The group may find a scapegoat and attack him/her with cruelty, or identify sub-groups as enemies and fight them.

In situations like these the group leaders deal with a complicated and difficult countertransference, because the emotional and psychological processes in the group challenge the leader’s ability to maintain an objective viewpoint. This can happen either because of the intensity or the fact that the leaders are also involved with these sociological processes.

These situations make it difficult for the group-leaders to secure the group boundaries and remain sensitive to the inner worlds of the participant and/or the whole group. The threatening reality enters the group forcefully through its contents and dynamics. For example: after a terror attack with many casualties, the group was talking about what happened. Although the group therapist thought that this conversation was related to the aggression in the group, it was hard for him to say anything about it. Another vivid example followed the assassination of the Israeli Prime Minister Rabin. Only a non-Israeli group therapist could interpret the discussion in the group about the event as unconsciously expressing a wish or fear from exterminating the group leader. A very clear example of this difficulty was the situation in Israel during the Gulf War (1991). Citizens had to remain in sealed rooms, fearing a gas attack from Iraq. The group therapists that tried to continue groups in sealed rooms were sharing the same anxiety, distress and uncertainty as the group participants.

Compared to other countries, the level of interpersonal tolerance in the beginning of an Israeli group is quite low, and the level of aggression is quite high. Actually this phenomenon is correlated with some psychological aspects typical of Israeli society: Israelis tend to express aggression when they feel vulnerable. Hiding weakness and presenting apparent strength is the cultural norm. This may be a result of the need to be different from the Jew from the Diaspora who is perceived as weak and therefore chased. It is clear that years of living in a country surrounded by enemies enforced the need not to reveal any signs of weakness. In the group, expressions of anger replace vulnerability or pain, and group therapists must be empathic to this.

Another typical characteristic of life in Israel is permanent intrusion and breaking personal boundaries. Practically this can be expressed in insensitive comments that impinge privacy (such as commenting about the other’s look or dress) or with personal questions that in any other place in the world would seem rude. It takes a long time for a group to learn to give effective and unoffending feedback and to show interest in others with real care and empathy.

Another aspect of boundaries is the Israeli tendency to break any rule, test the limits, and reject authority. The Israelis do not like being told what to do. The group contract, e.g., time limits, can be a serious obstacle to the group work. In contrast to the US, where the participants usually collaborate and cooperate with authority, an Israeli’s initial reaction is to test the limits. Being on time is a rare phenomenon; coming late to the group is typical. There are other countries where it may be difficult to start the group on time, e.g., in South America, where there are different societal norms regarding time.

People who grew up in the kibbutz are one of the special populations. The influence of the kibbutzim on the Israeli society and the national ethos is greater than would be expected by the small percentage of the kibbutz members in the general population. The kibbutz-born are regarded as the elite of the Israeli society. A large proportion of them volunteer to serve in the special-best units of the Israeli Defence Force or become officers in the army. Usually, the kibbutz-born are very conforming and are easily influenced by social pressure. The kibbutz experience is a group experience. When students who come to study group work are asked about their first memory of a group, there are always some people who would say “all my life I remember myself in a group.” These are the kibbutz-born. They live in a group from birth, are toile- trained together, eat in a group, take showers together, and in the past they also slept together in the “children-house” and not with their parents. These facts largely influence their personality and relation to the group. Along with the many advantages that growing up in a group has, there are also many disadvantages, especially being quite conformists, yielding to social consensus and having difficulty expressing their individuality.

One’s personal history of early group experiences and one’s experience of the family of origin accompanies a new group member. For “kibbutz graduates,” the experience is always associated with the primary kibbutz group and usually the associations are negative. “Kibbutz refugees” are usually deterred from joining a therapeutic group because for them, who are coming from a culture of conformity and yielding to group pressure, the group is perceived as freedom-robbing and not as enhancing personal space.

Another population frequently met in therapeutic groups is the second generation of Holocaust survivors. Much has been written about this population and its specific characteristics. As mentioned before, there are special groups for Holocaust survivors and their offspring as well as specific organizations that offer psychological services solely for this population. Unique behavior patterns typical of this population are evident in the developing relationships in the group. One sees great sensitivity to guilt feelings and a tendency to take upon oneself excessive guilt or react with anger to criticism, over-protection in relation to others in the group and excessive sensitivity to the others’ needs while not listening to the needs of the self.. Additionally, one observes difficulty in dealing with aggression and self-assertion. All these and others are salient in the group. Working through them in the “here and now” and connecting them to their sources can help to effect changes in these interpersonal patterns.

Israeli society is a “melting pot,” integrating immigrants from all over the world. Although the major immigrations have ended and the proportion of the Israeli-born is growing, it is not rare to find people who were born in Argentina, the former USSR or the US in one therapy group. It is common to have patients whose parents emigrated from diverse locations, e.g., Eastern and Western Europe, Asia and Africa. This phenomenon creates a rich and colorful texture in describing the background of each of the group members. In the same group you can hear about Polish parents who seed guilt feelings in their children and about Moroccan parents who emotionally tie their children through the tribal enmeshment of the extended family. Initially, the group members may sound very different from one another, as everyone comes from a different background with very different norms and cultural values. In addition, as it happens in society at large, it may create status differences and stereotypes or judgmental evaluation of people from different origins. The task of the group-leader is to help the group members to bridge the gaps and find the similarities between different congregations without relinquishing the uniqueness of each participant.

In this article I tried to describe group psychotherapy and group work in Israel. Group leading in Israel has some unique features frequently expressed in the subjects addressed in the group (Holocaust, terror and social conflicts), typical populations (kibbutz born, second generation of Holocaust survivors, and immigrants from different nations), and in typical Israeli dynamics (expressions of aggression and criticism, intrusion and difficulty with boundaries.)

Group work in Israel has been growing and expanding in recent years. Although the training of group therapists in Israel is kept on high standards and there are quality group psychotherapists, little is known of this work outside Israel.

It is my hope that this article serves as an introduction to the group therapy work that we are doing in Israel as well as contributing to an understanding of our unique cultural challenges as they relate to psychotherapy. As worldwide communication expands, cross-pollination of ideas and experiences enriches clinicians of all nationalities and persuasions.

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